Provider Demographics
NPI:1073752630
Name:CARDON, TERESA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:CARDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 S CABRIO TER
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-9671
Mailing Address - Country:US
Mailing Address - Phone:509-251-0774
Mailing Address - Fax:
Practice Address - Street 1:4660 S CABRIO TER
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-9671
Practice Address - Country:US
Practice Address - Phone:509-251-0774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8420934-2506103K00000X
AZSLP4237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst