Individual
TABITHA MARIE LEQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APSW
Contact information
Practice address
N5682 COUNTY ROAD K, FOND DU LAC, WI 54937-7908
(877) 300-9101
Mailing address
631 4TH ST, FOND DU LAC, WI 54935-5309
(920) 904-6762
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
134414-121
WI
Other
Enumeration date
07/06/2023
Last updated
07/06/2023
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