Provider Demographics
NPI:1538480868
Name:WELLS, TERESA GARCIA (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:GARCIA
Last Name:WELLS
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 1:2900 WOODRIDGE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-2506
Mailing Address - Country:US
Mailing Address - Phone:713-741-5800
Mailing Address - Fax:
Practice Address - Street 1:2900 WOODRIDGE DR STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-2506
Practice Address - Country:US
Practice Address - Phone:713-741-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103603235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX76-0693728OtherEMPLOYER IDENTIFICATION NUMBER