Provider Demographics
NPI:1013443605
Name:GRASHAM, TERRI LYNN
Entity Type:Individual
Prefix:MISS
First Name:TERRI
Middle Name:LYNN
Last Name:GRASHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TERRI
Other - Middle Name:LYNN
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2650 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2029
Mailing Address - Country:US
Mailing Address - Phone:325-660-1674
Mailing Address - Fax:
Practice Address - Street 1:245 N 3RD E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-2734
Practice Address - Country:US
Practice Address - Phone:208-587-8255
Practice Address - Fax:208-587-4475
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist