Provider Demographics
NPI:1295319911
Name:TEED, EMILY A (CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:TEED
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 VILLAGE GREEN RD
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-1507
Mailing Address - Country:US
Mailing Address - Phone:908-340-5831
Mailing Address - Fax:
Practice Address - Street 1:21 E HIGH ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2320
Practice Address - Country:US
Practice Address - Phone:908-458-6267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-09
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJDATEMP-03671235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty