Provider Demographics
NPI:1447588702
Name:TOURDOT, ANGELA (MSSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:TOURDOT
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33924 ROBIN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:WI
Mailing Address - Zip Code:53924-8101
Mailing Address - Country:US
Mailing Address - Phone:608-986-2150
Mailing Address - Fax:
Practice Address - Street 1:425 6TH ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1202
Practice Address - Country:US
Practice Address - Phone:608-524-7987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6502-11104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker