Provider Demographics
NPI:1699978213
Name:STOLTZ, TERRI LYNN (MS-CCC)
Entity type:Individual
Prefix:MS
First Name:TERRI
Middle Name:LYNN
Last Name:STOLTZ
Suffix:
Gender:F
Credentials:MS-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 HUNTERS POINT CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-1421
Mailing Address - Country:US
Mailing Address - Phone:502-836-4363
Mailing Address - Fax:
Practice Address - Street 1:4707 HUNTERS POINT CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1421
Practice Address - Country:US
Practice Address - Phone:502-836-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0568235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY06-1816292Medicare UPIN