| Doctor Name: | TERRI DODGE |
| NPI Number: | 1134555626 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CADC |
| License Number: | |
| Business Practice Address: | 126 S 1st W Rigby, ID - 834421307 |
| Business Phone Number: | 2085212647 |
| Business Fax Number: | |
| Mailing Address: | 126 S 1st W, RIGBY |
| State: | ID |
| Postal Code: | 834421307 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/17/2013 |
| NPI Last Update Date: | 09/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |