Individual
TERESA M. NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
625 W WASHINGTON AVE, MADISON, WI 53703-2637
(608) 280-2700
Mailing address
625 W WASHINGTON AVE, MADISON, WI 53703-2637
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
224-122
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114221413
—
WI
Enumeration date
12/29/2010
Last updated
10/20/2011
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