Provider Demographics
NPI:1366594475
Name:CHAVEZ, TERESA J (MS, CCC, SLP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:J
Last Name:CHAVEZ
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 1:206 N MIDKIFF RD
Mailing Address - Street 2:SUITE 2-C
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6211
Mailing Address - Country:US
Mailing Address - Phone:432-218-7857
Mailing Address - Fax:432-218-7917
Practice Address - Street 1:206 N MIDKIFF RD
Practice Address - Street 2:SUITE 2-C
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6211
Practice Address - Country:US
Practice Address - Phone:432-218-7857
Practice Address - Fax:432-218-7917
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14849235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist