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Individual

TANSI MCQUEEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1095 MIDWAY RD, MENASHA, WI 54952-1115
(920) 720-2300
Mailing address
PO BOX 8003, APPLETON, WI 54912-8003
(920) 996-3298

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12870
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
39167900
WI
Enumeration date
01/03/2007
Last updated
07/08/2007
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