Provider Demographics
NPI:1427450048
Name:MAYER, TERRI LYNN (CCG)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:MAYER
Suffix:
Gender:
Credentials:CCG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 N MERRIE ST
Mailing Address - Street 2:
Mailing Address - City:NEWMAN LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99025-9667
Mailing Address - Country:US
Mailing Address - Phone:509-590-7194
Mailing Address - Fax:
Practice Address - Street 1:5020 N MERRIE ST
Practice Address - Street 2:
Practice Address - City:NEWMAN LAKE
Practice Address - State:WA
Practice Address - Zip Code:99025-9667
Practice Address - Country:US
Practice Address - Phone:509-590-7194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA524476172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker