Provider Demographics
NPI:1063440360
Name:HUBER, TERESE IRENE (AUD)
Entity type:Individual
Prefix:DR
First Name:TERESE
Middle Name:IRENE
Last Name:HUBER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4036 GROVE HILL CT
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1922
Mailing Address - Country:US
Mailing Address - Phone:770-781-2376
Mailing Address - Fax:770-781-2377
Practice Address - Street 1:6130 SOUTHARD TRCE
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-6475
Practice Address - Country:US
Practice Address - Phone:770-781-2376
Practice Address - Fax:770-781-2377
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003591231H00000X, 231HA2400X, 237600000X, 231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA614451647AMedicaid
GA614451647BMedicaid
GA614451647AMedicaid
GAS88337Medicare UPIN