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General NPI Number Information
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NPI Number | 1477515724
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Entity Type | Individual
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Provider Name | TERESA DEER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 11/10/2023
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Provider Practice Location Address
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Address Line | 5017 GREEN BAY RD STE 130
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City | KENOSHA
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State | WI
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Zip | 53144-1782
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Country | US
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Telephone | 262-672-1334
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Fax | 855-277-2812
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Provider Business Mailing Address
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Address Line | 5017 GREEN BAY RD STE 130
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City | KENOSHA
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State | WI
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Zip | 53144-1782
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Country | US
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Telephone | 262-672-1334
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Fax | 855-277-2812
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 2518-057
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2518-057
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 071-006765
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License Number State | IL
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