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General NPI Number Information
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NPI Number | 1215101100
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Entity Type | Organization
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Legal Business Name | TERESA M CECIL
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 2600 WILSHIRE AVE
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-1571
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Country | US
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Telephone | 765-414-0157
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Fax | 765-497-0363
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Provider Business Mailing Address
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Address Line | PO BOX 2067
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City | WEST LAFAYETTE
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State | IN
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Zip | 47996-2067
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Country | US
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Telephone | 765-414-0157
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Fax | 765-497-0363
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Authorized Official
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Title or Position | OWNER SPEECH LANGUAGE PATHOLOGIST
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Name | MS. TERESA MARIE CECIL
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Credential | CCC SLP
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Telephone | 765-414-0157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 22001428A
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License Number State | IN
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