Provider Demographics
NPI:1225434244
Name:THOMPSON, TUANQUILLA MONTESSA (APSW)
Entity Type:Individual
Prefix:MRS
First Name:TUANQUILLA
Middle Name:MONTESSA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:500 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1060
Mailing Address - Country:US
Mailing Address - Phone:262-900-2795
Mailing Address - Fax:
Practice Address - Street 1:3536 52ND ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-2662
Practice Address - Country:US
Practice Address - Phone:262-842-0538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WI16904-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor