Provider Demographics
NPI:1386709368
Name:JUST, TERESA R (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:R
Last Name:JUST
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4124
Mailing Address - Country:US
Mailing Address - Phone:361-389-9114
Mailing Address - Fax:
Practice Address - Street 1:2500 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4169
Practice Address - Country:US
Practice Address - Phone:361-661-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102894235Z00000X
WI1551-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1551-154OtherSPEECH PATHOLOGIST
TX102894OtherSPEECH PATHOLOGIST