Provider Information for 1871622332
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TERESA W SYVERSEN CADC I
Other Names:Other Name:TERRI W SYVERSEN CADC ISex: Female
NPI: 1871622332
Last Updated: 2007-07-09
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1871622332 | ||||||||
| Enumeration Date | 2007-03-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 9875 CHANCE RD TILLAMOOK, OR 97141 United States Phone: 503-842-8201 | Fax:503-815-1870 | ||||||||
| Primary Practice Address | 906 MAIN AVE TILLAMOOK, OR 97141-3816 United States Phone: 503-842-8201 | Fax:503-815-1870 | ||||||||
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