Individual
MRS. TORY PHONSAVAN KOETTERHAGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
W236S4564 WHISPERING HILLS CT, WAUKESHA, WI 53189-9772
(414) 467-6994
Mailing address
W236S4564 WHISPERING HILLS CT, WAUKESHA, WI 53189-9772
(414) 467-6994
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8075-123
WI
Other
Enumeration date
10/15/2018
Last updated
10/15/2018
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