Individual
TERESA A SOUDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
504 E 8TH AVE, BRODHEAD, WI 53520-1106
(267) 349-4816
Mailing address
504 E 8TH AVE, BRODHEAD, WI 53520-1106
(267) 349-4816
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8718-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098304
ANTHEM LEGACY NUMBER
ME
05
—
432407099
—
ME
Enumeration date
12/01/2006
Last updated
10/08/2024
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