Provider Demographics
NPI:1801271796
Name:MASTEN, TERRIE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:
Last Name:MASTEN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 PRINCIPIA CT
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4657
Mailing Address - Country:US
Mailing Address - Phone:909-964-5397
Mailing Address - Fax:
Practice Address - Street 1:7251 MEADOWLARK PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-6314
Practice Address - Country:US
Practice Address - Phone:909-964-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP18701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist