Provider Demographics
NPI:1700082757
Name:ALSUM, TERESE DIANE (AUD)
Entity Type:Individual
Prefix:
First Name:TERESE
Middle Name:DIANE
Last Name:ALSUM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:TERESE
Other - Middle Name:DIANE
Other - Last Name:TAMELING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2225 MAIN ST SW
Mailing Address - Street 2:STE 140
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9697
Mailing Address - Country:US
Mailing Address - Phone:616-538-8220
Mailing Address - Fax:
Practice Address - Street 1:2225 MAIN ST SW STE 140
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9697
Practice Address - Country:US
Practice Address - Phone:616-538-8220
Practice Address - Fax:616-538-8991
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000325231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M37680009Medicare PIN