Basic Information
| Provider Information | |||||||||
| NPI: | 1487804233 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELLAVANCE | ||||||||
| FirstName: | TERRA | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MA, CCC/SLP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | WIGGINS | ||||||||
| OtherFirstName: | TERRA | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherCredential: | MA, CCC/SLP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 211 FRIDAY CENTER DR | ||||||||
| Address2: | SUITE 2091, ROOM 2012 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275179499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199660420 | ||||||||
| FaxNumber: | 9199669983 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MANNING DR | ||||||||
| Address2: | G0303 NEUROSCIENCES, DEPT OF AUDIOLOGY AND SPEECH PATH | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275144220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198430425 | ||||||||
| FaxNumber: | 9199668690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2008 | ||||||||
| LastUpdateDate: | 12/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7296 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.