Provider Demographics
NPI:1871622332
Name:SYVERSEN, TERESA W (CADC I)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:W
Last Name:SYVERSEN
Suffix:
Gender:F
Credentials:CADC I
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:W
Other - Last Name:SYVERSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC I
Mailing Address - Street 1:9875 CHANCE RD
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141
Mailing Address - Country:US
Mailing Address - Phone:503-842-8201
Mailing Address - Fax:503-815-1870
Practice Address - Street 1:906 MAIN AVE
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-3816
Practice Address - Country:US
Practice Address - Phone:503-842-8201
Practice Address - Fax:503-815-1870
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR197749Medicaid
OR197749Medicaid