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Provider Information for 1396250643


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TERESA M THIEL


Sex: Female

NPI: 1396250643
Last Updated: 2023-06-26
Certification Date: 2023-06-26

Details

NameValue
NPI1396250643
Enumeration Date2017-12-08
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 308 3RD ST
MENASHA, WI 54952-2713
United States

Phone: 920-252-6076 | Fax:
 
Primary Practice Address 308 3RD ST
MENASHA, WI 54952-2713
United States

Phone: 920-252-6076 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 101YP2500X - Counselor - ProfessionalWI7768-125
Yes 101YP2500X - Counselor - Professional