Provider Demographics
NPI:1104239599
Name:SWEENEY, THERESA M (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 TAMARACK RD STE 400
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6984
Mailing Address - Country:US
Mailing Address - Phone:270-903-1068
Mailing Address - Fax:270-685-2058
Practice Address - Street 1:1115 TAMARACK RD STE 400
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6984
Practice Address - Country:US
Practice Address - Phone:270-903-1068
Practice Address - Fax:270-685-2058
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSLPLPA00218471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist