Healthcare Provider Details

I. General information

NPI: 1124940697
Provider Name (Legal Business Name): IRENE MARIE TENEYCK SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SOUTH AVE
LA CROSSE WI
54601-5467
US

IV. Provider business mailing address

1900 SOUTH AVE
LA CROSSE WI
54601-5467
US

V. Phone/Fax

Practice location:
  • Phone: 608-775-3652
  • Fax: 608-775-4354
Mailing address:
  • Phone: 608-775-3652
  • Fax: 608-775-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9127-120
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: