Provider Demographics
NPI:1720223357
Name:MASE, TERESA LYNN (HIS)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LYNN
Last Name:MASE
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 S MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1621
Mailing Address - Country:US
Mailing Address - Phone:734-627-7294
Mailing Address - Fax:734-433-9211
Practice Address - Street 1:1171 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1621
Practice Address - Country:US
Practice Address - Phone:734-627-7294
Practice Address - Fax:734-433-9211
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001212A237700000X
MI3502013266237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist