Provider Demographics
NPI:1154558435
Name:REILLY, THERESA MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:MARIE
Last Name:REILLY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:MARIE
Other - Last Name:TRIOLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:22 ELBOW LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-5502
Mailing Address - Country:US
Mailing Address - Phone:526-513-0757
Mailing Address - Fax:
Practice Address - Street 1:8460 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2544
Practice Address - Country:US
Practice Address - Phone:718-298-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist