Individual
THERESE MATTINGLY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.S., LCSW, LMFT
Contact information
Practice address
1 S MAIN ST, JANESVILLE, WI 53545-3922
(608) 757-0404
Mailing address
402 E HOLMES ST, JANESVILLE, WI 53545-4116
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3146123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39293700
—
WI
Enumeration date
03/03/2006
Last updated
07/08/2007
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