Provider Demographics
NPI:1942571609
Name:WOOD, TERYL JEAN (SLPD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TERYL
Middle Name:JEAN
Last Name:WOOD
Suffix:
Gender:F
Credentials:SLPD, CCC-SLP
Other - Prefix:
Other - First Name:TERYL
Other - Middle Name:
Other - Last Name:BASINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:1688 MOUNTAIN VIEW RD E
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-8338
Mailing Address - Country:US
Mailing Address - Phone:208-340-9903
Mailing Address - Fax:
Practice Address - Street 1:1688 MOUNTAIN VIEW RD E
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-8338
Practice Address - Country:US
Practice Address - Phone:208-340-9903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61157123235Z00000X
CA19509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist