Individual
THERESA JOAN ZAKUTANSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
910 ELM GROVE RD STE 11B, ELM GROVE, WI 53122-2531
(262) 780-1001
(262) 780-1002
Mailing address
910 ELM GROVE RD STE 11B, ELM GROVE, WI 53122-2531
(262) 780-1001
(262) 780-1002
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1828-132
WI
1041C0700X
Clinical Social Worker
Primary
1941-123
WI
106H00000X
Marriage & Family Therapist
383-124
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205993482
—
WI
Enumeration date
01/03/2007
Last updated
05/09/2017
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