Provider Demographics
NPI:1437290806
Name:NIEDERKORN, TERRY
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:
Last Name:NIEDERKORN
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 1:9348 HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:BROSELEY
Mailing Address - State:MO
Mailing Address - Zip Code:63932
Mailing Address - Country:US
Mailing Address - Phone:573-328-4321
Mailing Address - Fax:573-328-1070
Practice Address - Street 1:9348 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:BROSELEY
Practice Address - State:MO
Practice Address - Zip Code:63932
Practice Address - Country:US
Practice Address - Phone:573-328-4321
Practice Address - Fax:573-328-1070
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO02079235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist