Provider Demographics
NPI:1477806313
Name:NUGENT, TERI LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:LYNN
Last Name:NUGENT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 STATE ROAD 70
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:WI
Mailing Address - Zip Code:54893-9251
Mailing Address - Country:US
Mailing Address - Phone:715-349-2195
Mailing Address - Fax:715-349-8528
Practice Address - Street 1:N6628 METCALF RD
Practice Address - Street 2:
Practice Address - City:STONE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54876-8817
Practice Address - Country:US
Practice Address - Phone:715-558-5377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor