Healthcare Provider Details

I. General information

NPI: 1699294017
Provider Name (Legal Business Name): TERESA PATTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERESA DANTZLER

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 LINCOLNWAY
VALPARAISO IN
46383-5727
US

IV. Provider business mailing address

2208 W 58TH AVE
MERRILLVILLE IN
46410-2214
US

V. Phone/Fax

Practice location:
  • Phone: 219-548-8727
  • Fax:
Mailing address:
  • Phone: 773-719-1873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: