Provider Demographics
NPI:1225878127
Name:TESCH, TERESA (SAC-IT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:TESCH
Suffix:
Gender:F
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 BERLIK ST
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-1308
Mailing Address - Country:US
Mailing Address - Phone:715-574-5740
Mailing Address - Fax:
Practice Address - Street 1:901 N 6TH ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4718
Practice Address - Country:US
Practice Address - Phone:715-848-5022
Practice Address - Fax:888-778-6750
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20370101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)