Basic Information
| Provider Information | |||||||||
| NPI: | 1912021312 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TETER | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | GIFFORD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AU.D., F-AAA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 HAWKES TRL | ||||||||
| Address2: | |||||||||
| City: | WEBSTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145804211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5856725761 | ||||||||
| FaxNumber: | 5852447126 | ||||||||
| Practice Location | |||||||||
| Address1: | 2234 N WAHSATCH AVE | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809076940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196322376 | ||||||||
| FaxNumber: | 7196332327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 01/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 11454844 | 01 | NY | CAQH PROVIDER ID NUMBER | OTHER |