Provider Demographics
NPI:1699011619
Name:TUESCHER, KIMBERLY DIANE
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DIANE
Last Name:TUESCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 RAYOVAC DRIVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711
Mailing Address - Country:US
Mailing Address - Phone:608-276-9191
Mailing Address - Fax:608-276-9144
Practice Address - Street 1:700 RAYOVAC DRIVE
Practice Address - Street 2:SUITE 220
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711
Practice Address - Country:US
Practice Address - Phone:608-276-9191
Practice Address - Fax:608-276-9144
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4948-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional