Healthcare Provider Details

I. General information

NPI: 1215101100
Provider Name (Legal Business Name): TERESA M CECIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 WILSHIRE AVE
WEST LAFAYETTE IN
47906-1571
US

IV. Provider business mailing address

PO BOX 2067
WEST LAFAYETTE IN
47996-2067
US

V. Phone/Fax

Practice location:
  • Phone: 765-414-0157
  • Fax: 765-497-0363
Mailing address:
  • Phone: 765-414-0157
  • Fax: 765-497-0363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22001428A
License Number StateIN

VIII. Authorized Official

Name: MS. TERESA MARIE CECIL
Title or Position: OWNER SPEECH LANGUAGE PATHOLOGIST
Credential: CCC SLP
Phone: 765-414-0157