Individual
IRVIN W TIESKOTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADCI
Contact information
Practice address
212 11TH ST S, LA CROSSE, WI 54601-4116
(608) 392-9555
(608) 392-9432
Mailing address
212 11TH ST S, LA CROSSE, WI 54601-4116
(608) 392-9555
(608) 392-9432
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1238
WI
Other
Enumeration date
12/28/2010
Last updated
12/28/2010
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