Provider Demographics
NPI:1821224189
Name:CLAY, TERRI LYNN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LYNN
Last Name:CLAY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MRS
Other - First Name:TERRI
Other - Middle Name:LYNN
Other - Last Name:FECHTLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:2814 S. BALTIMORE
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501
Mailing Address - Country:US
Mailing Address - Phone:660-785-1834
Mailing Address - Fax:660-785-1825
Practice Address - Street 1:2814 S. BALTIMORE
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501
Practice Address - Country:US
Practice Address - Phone:660-785-1834
Practice Address - Fax:660-785-1825
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1821224189Medicaid
MOMA1811009Medicare PIN
MO1821224189Medicaid