Individual
MS. TERESA DAWN LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SP
Contact information
Practice address
1125 DIXIE HWY, MITCHELL, IN 47446-6737
(812) 583-6414
(812) 849-5225
Mailing address
1125 DIXIE HWY, MITCHELL, IN 47446-6737
(812) 583-6414
(812) 849-5225
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22001291A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00211144
AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION
—
01
—
200861830A
LEGACY PROVIDER IDENTIFIER (LPI)
IN
01
—
22001291A
INDIANA PROFESSIONAL LICENSING AGENCY LICENSE NUMBER
IN
Enumeration date
04/30/2008
Last updated
04/30/2008
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