Provider Demographics
NPI:1225287543
Name:DAFFRON, TERASA LEE
Entity Type:Individual
Prefix:MRS
First Name:TERASA
Middle Name:LEE
Last Name:DAFFRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6156
Mailing Address - Country:US
Mailing Address - Phone:209-577-1014
Mailing Address - Fax:209-577-8046
Practice Address - Street 1:611 SCENIC DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6156
Practice Address - Country:US
Practice Address - Phone:209-577-1014
Practice Address - Fax:209-577-8046
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA5008237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist