Provider Demographics
NPI:1336672153
Name:TESKA, COLLEEN (LAC, DACOM)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:TESKA
Suffix:
Gender:F
Credentials:LAC, DACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 943
Mailing Address - Street 2:
Mailing Address - City:GYPSUM
Mailing Address - State:CO
Mailing Address - Zip Code:81637-0943
Mailing Address - Country:US
Mailing Address - Phone:262-208-4776
Mailing Address - Fax:
Practice Address - Street 1:960 CHAMBERS AVE STE 202
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631-6573
Practice Address - Country:US
Practice Address - Phone:262-208-4776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI962-55171100000X
TXAC171100000X
COACU.0002504171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist