Healthcare Provider Details

I. General information

NPI: 1669722690
Provider Name (Legal Business Name): TEREZA WASSON M.A.LIC/CCC-SLP TSLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 TOTEM TRL
ROCHESTER NY
14617-2473
US

IV. Provider business mailing address

288 TOTEM TRL
ROCHESTER NY
14617-2473
US

V. Phone/Fax

Practice location:
  • Phone: 585-831-6490
  • Fax:
Mailing address:
  • Phone: 585-831-6490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14064894
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number022912-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: