MEDICARE: TERESA CRAIG

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
1	235Z00000X	Speech-Language Pathologist	41YS01024300	NJ

General Provider Information

NPI Number	:	1518597376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA CRAIG

Provider Business Mailing Address
First Line	:	18 BALA RD
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08002-1307
Country	:	US
Telephone Number	:	609-651-3424
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 EVES DR STE 308
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-3129
Country	:	US
Telephone Number	:	609-651-3424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2020
Last Update Date	:	01/21/2020

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Directions to “ TERESA CRAIG ” Practice Location

Language	Start Address	Practice Location

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