Provider Demographics
NPI:1629320254
Name:HESCOCK, TERRA YVETTE
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:YVETTE
Last Name:HESCOCK
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 1:904 G STREET
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501
Mailing Address - Country:US
Mailing Address - Phone:707-269-9590
Mailing Address - Fax:707-444-8012
Practice Address - Street 1:2413 2ND STREET
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-269-9590
Practice Address - Fax:707-444-8012
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator