Provider Demographics
NPI:1477243053
Name:JOENS-PAUTZKE, TERESA ELLEN (BA,LADC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ELLEN
Last Name:JOENS-PAUTZKE
Suffix:
Gender:F
Credentials:BA,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 COTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-4626
Mailing Address - Country:US
Mailing Address - Phone:320-593-2266
Mailing Address - Fax:
Practice Address - Street 1:642 COTTONWOOD AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55355-4626
Practice Address - Country:US
Practice Address - Phone:320-221-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305863101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)