Healthcare Provider Details

I. General information

NPI: 1982876439
Provider Name (Legal Business Name): TERESA CONN H.I.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 JUSTICE ST
MONROE LA
71201-3620
US

IV. Provider business mailing address

2200 JUSTICE ST
MONROE LA
71201-3620
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-2363
  • Fax:
Mailing address:
  • Phone: 318-605-3321
  • Fax: 318-605-4576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1191
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: