Provider Demographics
NPI:1285601054
Name:BURSON, TERESA LYNN (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LYNN
Last Name:BURSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16475 THOMPSON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAURELVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43135-9238
Mailing Address - Country:US
Mailing Address - Phone:740-332-7081
Mailing Address - Fax:
Practice Address - Street 1:565 CHILDRENS DR W
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2648
Practice Address - Country:US
Practice Address - Phone:614-228-5523
Practice Address - Fax:614-228-8249
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-5985235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist