Healthcare Provider Details

I. General information

NPI: 1699698399
Provider Name (Legal Business Name): TERESA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N58W19314 FOX RIVER WAY
MENOMONEE FALLS WI
53051-6350
US

IV. Provider business mailing address

N58W19314 FOX RIVER WAY
MENOMONEE FALLS WI
53051-6350
US

V. Phone/Fax

Practice location:
  • Phone: 414-982-9270
  • Fax:
Mailing address:
  • Phone: 414-982-9270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: