Provider Demographics
NPI:1134877475
Name:TEDESCO, TALIA MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:MARIE
Last Name:TEDESCO
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 1:3901 WRIGHTSVILLE AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6255
Mailing Address - Country:US
Mailing Address - Phone:910-679-8385
Mailing Address - Fax:
Practice Address - Street 1:3901 WRIGHTSVILLE AVE STE 210
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6255
Practice Address - Country:US
Practice Address - Phone:910-679-8385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL016011235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist