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Individual
KELLY JEAN TEACHOUT
Active
Individual
KELLY JEAN TEACHOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15541-132
WI
1041C0700X
Clinical Social Worker
8187
WI
Other
Enumeration date
01/13/2011
Last updated
06/20/2016
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