Provider Demographics
NPI:1134490196
Name:WALTERS, TERA LYNN DOZIER (MS, CFY-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TERA LYNN
Middle Name:DOZIER
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9031 BRYN MAWR CIR
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-8918
Mailing Address - Country:US
Mailing Address - Phone:251-680-9686
Mailing Address - Fax:
Practice Address - Street 1:9031 BRYN MAWR CIR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-8918
Practice Address - Country:US
Practice Address - Phone:251-680-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8489235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist