Healthcare Provider Details

I. General information

NPI: 1184295396
Provider Name (Legal Business Name): TENEKA S FERGUSON LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PARK AVE
IRONTON OH
45638-1502
US

IV. Provider business mailing address

PO BOX 108
IRONTON OH
45638-0108
US

V. Phone/Fax

Practice location:
  • Phone: 740-532-1613
  • Fax: 740-879-0599
Mailing address:
  • Phone: 740-532-1613
  • Fax: 740-879-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-1600242-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: