Provider Demographics
NPI:1134490196
Name:WALTERS, TERA LYNN DOZIER (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TERA LYNN
Middle Name:DOZIER
Last Name:WALTERS
Suffix:
Gender:
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 RIDGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-2838
Mailing Address - Country:US
Mailing Address - Phone:251-680-9686
Mailing Address - Fax:
Practice Address - Street 1:110 AMBER LN
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-8623
Practice Address - Country:US
Practice Address - Phone:251-680-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2025-02-27
Deactivation Date:2024-11-18
Deactivation Code:
Reactivation Date:2025-02-13
Provider Licenses
StateLicense IDTaxonomies
MSS4993235Z00000X
AL3432235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist