Provider Demographics
NPI:1316048325
Name:ACKERLUND, TERESA M (ATA)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:M
Last Name:ACKERLUND
Suffix:
Gender:F
Credentials:ATA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18709 JOLLY RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-5004
Mailing Address - Country:US
Mailing Address - Phone:360-707-2013
Mailing Address - Fax:
Practice Address - Street 1:502 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2922
Practice Address - Country:US
Practice Address - Phone:360-417-7539
Practice Address - Fax:360-416-7556
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00042504101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health