| Doctor Name: | MRS. TERESA ANN DETLEFSEN |
| NPI Number: | 1861861833 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 314 W 1st St Ogallala, NE - 691532520 |
| Business Phone Number: | 3082848481 |
| Business Fax Number: | |
| Mailing Address: | Po Box 915, OGALLALA |
| State: | NE |
| Postal Code: | 691530915 |
| Phone Number: | 3082848481 |
| Fax Number: | |
| NPI Enumeration Date: | 09/21/2015 |
| NPI Last Update Date: | 09/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2355S0801X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Specialist/Technologist |
| Taxonomy Specialization: | Speech-Language Assistant |
| Taxonomy Definition: | |