Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 3788 | WI |
NPI | 1003315334 |
---|---|
Provider Name | Nicole M. Tesch |
First Address | Wausau, WI 54403-6785 |
Second Address | Wausau, WI 54403-6785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2018 |
Last Update Date | 01/02/2018 |