MEDICARE: MRS. TERILYN PRINCESS POTTER

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	SP-1153	NV

General Provider Information

NPI Number	:	1992486120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERILYN PRINCESS POTTER

Provider Business Mailing Address
First Line	:	7608 CRUZ BAY CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-461-7928
Fax Number	:

Provider Business Practice Location Address
First Line	:	7608 CRUZ BAY CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128
Country	:	US
Telephone Number	:	702-461-7928
Fax Number	:

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

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	07/31/2023

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Directions to “ MRS. TERILYN PRINCESS POTTER ” Practice Location

Language	Start Address	Practice Location

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