Provider Demographics
NPI:1477515724
Name:DEER, TERESA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:DEER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5017 GREEN BAY RD STE 130
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1782
Mailing Address - Country:US
Mailing Address - Phone:262-672-1334
Mailing Address - Fax:855-277-2812
Practice Address - Street 1:5017 GREEN BAY RD STE 130
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1782
Practice Address - Country:US
Practice Address - Phone:262-672-1334
Practice Address - Fax:855-277-2812
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2518-057103G00000X, 103T00000X
IL071-006765103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635716OtherBLUE CROSS/ BLUE SHIELD
IL0001635716OtherBLUE CROSS/ BLUE SHIELD
IL212683Medicare ID - Type Unspecified