Provider Demographics
NPI:1154528719
Name:CULLEN, THERESA MARIE (AUD ,CCC-A, FAAA)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MARIE
Last Name:CULLEN
Suffix:
Gender:F
Credentials:AUD ,CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3808
Mailing Address - Country:US
Mailing Address - Phone:508-775-0959
Mailing Address - Fax:
Practice Address - Street 1:60 NORTH ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3808
Practice Address - Country:US
Practice Address - Phone:508-775-0959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA447231H00000X, 231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner