Individual
SHELLY MARIE THEDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1541 ANNEX RD, JEFFERSON, WI 53549-9803
(920) 674-8700
Mailing address
1541 ANNEX RD, JEFFERSON, WI 53549-9803
(920) 674-8700
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
09/09/2020
Last updated
09/09/2020
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