Provider Demographics
NPI:1568193662
Name:WHITE, TERESA ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 JONES ST STE 108
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-7615
Mailing Address - Country:US
Mailing Address - Phone:815-291-1841
Mailing Address - Fax:
Practice Address - Street 1:210 JONES ST STE 108
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7615
Practice Address - Country:US
Practice Address - Phone:815-291-1841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA113068104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker