Provider Demographics
NPI:1720350143
Name:TEETERS, KRISTON DEANNE (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTON
Middle Name:DEANNE
Last Name:TEETERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KRISTON
Other - Middle Name:DEANNE
Other - Last Name:IRBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:207 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-1734
Mailing Address - Country:US
Mailing Address - Phone:541-296-5452
Mailing Address - Fax:
Practice Address - Street 1:207 W 3RD ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1734
Practice Address - Country:US
Practice Address - Phone:541-296-5452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator