Provider Demographics
NPI:1629686811
Name:JEPPSON, TERESE E
Entity Type:Individual
Prefix:
First Name:TERESE
Middle Name:E
Last Name:JEPPSON
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 1:1103 S WILLSON AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5248
Mailing Address - Country:US
Mailing Address - Phone:970-376-1425
Mailing Address - Fax:
Practice Address - Street 1:1103 S WILLSON AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5248
Practice Address - Country:US
Practice Address - Phone:970-376-1425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT43926101YM0800X
CO971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health