Provider Demographics
NPI:1578090999
Name:AHN, TERESA L (MA, CCC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:AHN
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001
Mailing Address - Country:US
Mailing Address - Phone:805-667-8200
Mailing Address - Fax:805-667-8201
Practice Address - Street 1:1234 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001
Practice Address - Country:US
Practice Address - Phone:805-667-8200
Practice Address - Fax:805-667-8201
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist