Provider Demographics
NPI:1336401231
Name:MAZZA, TERESA MARIE (AUD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MARIE
Last Name:MAZZA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:LYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:520 N MONTE VISTA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4674
Mailing Address - Country:US
Mailing Address - Phone:580-421-6470
Mailing Address - Fax:580-421-6472
Practice Address - Street 1:520 N MONTE VISTA ST
Practice Address - Street 2:SUITE B
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4674
Practice Address - Country:US
Practice Address - Phone:580-421-6470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3929231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist