Healthcare Provider Details

I. General information

NPI: 1639310493
Provider Name (Legal Business Name): KATHERINE JEAN TETER M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3459 WASHINGTON WATERLOO RD NE
WASHINGTON COURT HOUSE OH
43160-9016
US

IV. Provider business mailing address

3459 WASHINGTON WATERLOO RD NE
WASHINGTON COURT HOUSE OH
43160-9016
US

V. Phone/Fax

Practice location:
  • Phone: 740-606-5088
  • Fax: 740-422-0350
Mailing address:
  • Phone: 740-606-5088
  • Fax: 740-422-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6889
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: