Provider Demographics
NPI:1174964423
Name:MAISEL, TERESA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:MAISEL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25700 YORK RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3020
Mailing Address - Country:US
Mailing Address - Phone:248-797-6911
Mailing Address - Fax:248-548-5471
Practice Address - Street 1:25700 YORK RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3020
Practice Address - Country:US
Practice Address - Phone:248-797-6911
Practice Address - Fax:248-548-5471
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist