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NPI Code Detail

MEDICARE: CANDICE D TETREAULT MS/CCC-SLP

MEDICARE: CANDICE D TETREAULT MS/CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist5458NM
2235Z00000XSpeech-Language PathologistNCSLP-10331NC

General Provider Information

NPI Number : 1053757237
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDICE D TETREAULT MS/CCC-SLP
Provider Business Mailing Address
First Line : 16420 SPILLWAY DR
Second Line :
City : WAGRAM
State : NC
Zip : 28396-9563
Country : US
Telephone Number : 910-813-9964
Fax Number :
Provider Business Practice Location Address
First Line : 1357 WALTER REED RD STE 102
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-4417
Country : US
Telephone Number : 910-223-5543
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2013
Last Update Date : 03/17/2018

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Directions to “ CANDICE D TETREAULT MS/CCC-SLP” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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