Provider Demographics
NPI:1386163400
Name:SAWASKA, THERESA LYNN (SLP-CCC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNN
Last Name:SAWASKA
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12712 RAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:CEDAR LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46303-8654
Mailing Address - Country:US
Mailing Address - Phone:219-670-3558
Mailing Address - Fax:
Practice Address - Street 1:12712 RAVEN WAY
Practice Address - Street 2:
Practice Address - City:CEDAR LAKE
Practice Address - State:IN
Practice Address - Zip Code:46303-8654
Practice Address - Country:US
Practice Address - Phone:219-670-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist