Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 203-026 | WI |
NPI | 1558514893 |
---|---|
Provider Name | Ms. Terri L Nelson |
First Address | La Crosse, WI 54601-5467 |
Second Address | Onalaska, WI 54650-3109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2008 |
Last Update Date | 30/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
41057400 | (05) | WI |