Provider Demographics
NPI:1366695488
Name:HURT, TERESA LYNN (MCD,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LYNN
Last Name:HURT
Suffix:
Gender:F
Credentials:MCD,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203B W KINGSHIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-3430
Mailing Address - Country:US
Mailing Address - Phone:870-476-7090
Mailing Address - Fax:870-215-4479
Practice Address - Street 1:5203B W KINGSHIGHWAY
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-3430
Practice Address - Country:US
Practice Address - Phone:870-476-7090
Practice Address - Fax:870-215-4479
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1109235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129509721Medicaid