Provider Demographics
NPI:1295178051
Name:KUCZMARSKI, TERESA M (MS, LPC-IT)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:M
Last Name:KUCZMARSKI
Suffix:
Gender:F
Credentials:MS, LPC-IT
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:THORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-4718
Mailing Address - Country:US
Mailing Address - Phone:715-848-5022
Mailing Address - Fax:888-778-6750
Practice Address - Street 1:901 N 6TH ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4718
Practice Address - Country:US
Practice Address - Phone:715-848-5022
Practice Address - Fax:888-778-6750
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1369-226101YM0800X
WI5972-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100033670Medicaid