Provider Demographics
NPI:1194171546
Name:DELGADO, TSYOSHAAHT CATERINA (CADC III)
Entity type:Individual
Prefix:
First Name:TSYOSHAAHT
Middle Name:CATERINA
Last Name:DELGADO
Suffix:
Gender:F
Credentials:CADC III
Other - Prefix:
Other - First Name:CATERINA
Other - Middle Name:LYNN
Other - Last Name:MCLESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC III
Mailing Address - Street 1:1701 DOUSMAN ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-3211
Mailing Address - Country:US
Mailing Address - Phone:920-498-8600
Mailing Address - Fax:920-496-2027
Practice Address - Street 1:1701 DOUSMAN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3211
Practice Address - Country:US
Practice Address - Phone:920-498-8600
Practice Address - Fax:920-496-2027
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1208101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)