Provider Demographics
NPI:1457491847
Name:SHURSON, TEDD DENNIS (MA,CCCA)
Entity Type:Individual
Prefix:
First Name:TEDD
Middle Name:DENNIS
Last Name:SHURSON
Suffix:
Gender:M
Credentials:MA,CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 W WHITENDALE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-6131
Mailing Address - Country:US
Mailing Address - Phone:559-625-8960
Mailing Address - Fax:
Practice Address - Street 1:2316 W WHITENDALE AVE STE A
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-6131
Practice Address - Country:US
Practice Address - Phone:559-625-8960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU510231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ82321ZMedicaid
CA4034915Medicare UPIN