Teresa Rae Koppang, MS CCCSLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

LL60762859 Issued in WA

Practice address

38100 Antler LN
Battle Lake, MN 56515-9270

Phone

(952) 240-0551

NPI assigned

Mar 21, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Specialty

Qualified Speech Language Pathologist

Education

Other, 2007

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Achievement Center Inc.

  • Occupational Therapist
  • Woodbury, MN
  • NPI 1952411175

  Speech-Language Pathologist

  NPD (past)
• The Therapy Place

  • Rehabilitation Clinic/Center
  • Bloomington, MN
  • NPI 1609934173
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680134400000",
    "number": "1881865426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1044",
            "city": "LONG BEACH",
            "state": "WA",
            "postal_code": "986311044",
            "telephone_number": "952-240-0551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38100 ANTLER LN",
            "city": "BATTLE LAKE",
            "state": "MN",
            "postal_code": "565159270",
            "telephone_number": "952-240-0551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPPANG",
        "first_name": "TERESA",
        "middle_name": "RAE",
        "credential": "MS CCCSLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-21",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "8187",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "LL60762859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Cole
• Amy Louise Cory, RPH
• Kiana Marie Deal, PA-C
• Scott Edward Ellingson, D.C.
• Fergus Falls Medical Group, P.a.
• Kelly Ann Kruschke, DNP, FNP-BC, RN
• Midwest Community Residential Services, Inc.
• Jay Harvey Olson
• Otter Tail County
• Ruth Peterka

• Speech-Language Pathologist in Battle Lake, MN
• Providers in Battle Lake, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.