Provider Demographics
NPI:1528408788
Name:LIESER, TERI ANN (CNS)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:ANN
Last Name:LIESER
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 34TH ST NW APT 6
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-2974
Mailing Address - Country:US
Mailing Address - Phone:330-232-4709
Mailing Address - Fax:330-493-3761
Practice Address - Street 1:4974 HIGBEE AVE NW STE 209
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2562
Practice Address - Country:US
Practice Address - Phone:330-493-4553
Practice Address - Fax:330-493-3761
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14489-NS364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult