Provider Demographics
NPI:1316194251
Name:TERZAGHI, MARY ANNE (CCC/ SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY ANNE
Middle Name:
Last Name:TERZAGHI
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 1:229 POTOMAC RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3120
Mailing Address - Country:US
Mailing Address - Phone:610-639-4578
Mailing Address - Fax:
Practice Address - Street 1:401 GORDON DR STE A
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1276
Practice Address - Country:US
Practice Address - Phone:610-280-9201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL 007189235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist