Individual
MICHAEL TETKOSKI
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1312 W TOWNE SQUARE RD, MEQUON, WI 53092-5046
(262) 241-5099
Mailing address
1312 W TOWNE SQUARE RD, MEQUON, WI 53092-5046
(262) 241-5099
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1098-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39036200
—
WI
Enumeration date
05/30/2006
Last updated
07/08/2007
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