Provider Demographics
NPI:1720249238
Name:DUANE, TERRIE
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:
Last Name:DUANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 29TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3510
Mailing Address - Country:US
Mailing Address - Phone:510-832-3222
Mailing Address - Fax:510-832-5617
Practice Address - Street 1:475 29TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3510
Practice Address - Country:US
Practice Address - Phone:510-832-3222
Practice Address - Fax:510-832-5617
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16796235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist