Provider Demographics
NPI:1225289010
Name:HIATT, TERESA L (BGS)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:HIATT
Suffix:
Gender:F
Credentials:BGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N SALLY DR
Mailing Address - Street 2:
Mailing Address - City:WINAMAC
Mailing Address - State:IN
Mailing Address - Zip Code:46996-9100
Mailing Address - Country:US
Mailing Address - Phone:574-946-4233
Mailing Address - Fax:574-946-4365
Practice Address - Street 1:118 N SALLY DR
Practice Address - Street 2:
Practice Address - City:WINAMAC
Practice Address - State:IN
Practice Address - Zip Code:46996-9100
Practice Address - Country:US
Practice Address - Phone:574-946-4233
Practice Address - Fax:574-946-4365
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)