Healthcare Provider Details

I. General information

NPI: 1659116499
Provider Name (Legal Business Name): LAURIE PATRICIA TERJESON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SW 13TH ST PENDLETON EARLY LEARNING CENTER
PENDLETON OR
97801-1801
US

IV. Provider business mailing address

INTERMOUNTAIN ESD 331 SE BYERS AVE
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-3353
  • Fax: 541-966-3240
Mailing address:
  • Phone: 541-966-3141
  • Fax: 541-966-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11022
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: