Provider Demographics
NPI:1912021312
Name:TETER, JARED GIFFORD (AUD, F-AAA)
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:GIFFORD
Last Name:TETER
Suffix:
Gender:M
Credentials:AUD, F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HAWKES TRL
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-4211
Mailing Address - Country:US
Mailing Address - Phone:585-672-5761
Mailing Address - Fax:585-244-7126
Practice Address - Street 1:2234 N WAHSATCH AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6940
Practice Address - Country:US
Practice Address - Phone:719-632-2376
Practice Address - Fax:719-633-2327
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
NY14000018222237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11454844OtherCAQH PROVIDER ID NUMBER