Provider Demographics
NPI:1417349630
Name:KRAEMER, TERESE
Entity Type:Individual
Prefix:
First Name:TERESE
Middle Name:
Last Name:KRAEMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 HARTBROOK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-1444
Mailing Address - Country:US
Mailing Address - Phone:262-528-2015
Mailing Address - Fax:866-284-8107
Practice Address - Street 1:510 HARTBROOK DR STE 201
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-1444
Practice Address - Country:US
Practice Address - Phone:262-528-2015
Practice Address - Fax:866-284-8107
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2176-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional