Provider Demographics
NPI:1306082615
Name:HUMBERSTONE, TERRI ADAIR
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:ADAIR
Last Name:HUMBERSTONE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TERRI
Other - Middle Name:ADAIR
Other - Last Name:HALSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7064 STANDPIPE RD.
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:NY
Mailing Address - Zip Code:14530
Mailing Address - Country:US
Mailing Address - Phone:585-330-2697
Mailing Address - Fax:
Practice Address - Street 1:7064 STANDPIPE RD.
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:NY
Practice Address - Zip Code:14530
Practice Address - Country:US
Practice Address - Phone:585-330-2697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008381235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008381OtherSTATE LICENSE NEW YORK STATE