Provider Demographics
NPI:1073171526
Name:PEREIRA, MAGGIE TEREFENKO (SLP CCC)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:TEREFENKO
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THERAPY FUNDAMENTALS
Mailing Address - Street 2:511 INDEPENDENCE ROAD
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8202
Mailing Address - Country:US
Mailing Address - Phone:570-664-6005
Mailing Address - Fax:
Practice Address - Street 1:THERAPY FUNDAMENTALS
Practice Address - Street 2:511 INDEPENDENCE ROAD
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8202
Practice Address - Country:US
Practice Address - Phone:570-664-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA235Z00000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist