Individual
CARLY R TEBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
7818 MOLINE RD, WEBSTER, WI 54893-8545
(715) 866-8301
(715) 866-8374
Mailing address
PO BOX 309, SIREN, WI 54872-0309
(715) 349-7069
(888) 625-8634
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
131124-121
WI
1041C0700X
Clinical Social Worker
Primary
9566
WI
Other
Enumeration date
08/14/2018
Last updated
05/11/2021
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