Individual
KELLY JEAN TEACHOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSAC
Contact information
Practice address
313 4TH ST S, LA CROSSE, WI 54601-4047
(608) 782-7300
Mailing address
166 MAIN ST, WINONA, MN 55987-6442
(507) 454-4341
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15541-132
WI
1041C0700X
Clinical Social Worker
8187
WI
Other
Enumeration date
01/13/2011
Last updated
06/20/2016
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