Provider Demographics
NPI:1104348465
Name:HELGESON, THERESA (LSCSW)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:HELGESON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E968 GILARDI LN
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:WI
Mailing Address - Zip Code:54632-6800
Mailing Address - Country:US
Mailing Address - Phone:608-668-2332
Mailing Address - Fax:
Practice Address - Street 1:E968 GILARDI LN
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:WI
Practice Address - Zip Code:54632-6800
Practice Address - Country:US
Practice Address - Phone:608-386-5331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-08
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130453-121104100000X
IA1086501041C0700X
WI89681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1104348465Medicaid