Healthcare Provider Details

I. General information

NPI: 1477806313
Provider Name (Legal Business Name): TERI LYNN NUGENT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/28/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N6628 METCALF RD
STONE LAKE WI
54876-8817
US

IV. Provider business mailing address

4404 STATE ROAD 70
WEBSTER WI
54893-9251
US

V. Phone/Fax

Practice location:
  • Phone: 715-558-5377
  • Fax:
Mailing address:
  • Phone: 715-349-2195
  • Fax: 715-349-8528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: