Provider Demographics
NPI:1477829265
Name:EHMANN, TERRI S
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:S
Last Name:EHMANN
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 1:9470 HEALTHPARK CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3600
Mailing Address - Country:US
Mailing Address - Phone:239-433-8073
Mailing Address - Fax:239-482-7897
Practice Address - Street 1:9470 HEALTHPARK CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3600
Practice Address - Country:US
Practice Address - Phone:239-433-8073
Practice Address - Fax:239-482-7897
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW8186104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker