Provider Demographics
NPI:1124192661
Name:TELFER, TERRI L (MSW)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:TELFER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:IA
Mailing Address - Zip Code:50054-1039
Mailing Address - Country:US
Mailing Address - Phone:515-674-3500
Mailing Address - Fax:515-674-0300
Practice Address - Street 1:123 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:IA
Practice Address - Zip Code:50054-1039
Practice Address - Country:US
Practice Address - Phone:515-674-3500
Practice Address - Fax:515-674-0300
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA057911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI16010Medicare ID - Type Unspecified