Provider Demographics
NPI:1821136037
Name:TIEGLMAN KOEPP, LISA A (MSED LPC NCC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:TIEGLMAN KOEPP
Suffix:
Gender:F
Credentials:MSED LPC NCC
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:TIEGLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:805 E BADGER LN
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095
Mailing Address - Country:US
Mailing Address - Phone:262-306-0901
Mailing Address - Fax:262-306-0901
Practice Address - Street 1:1615 BARTON AVENUE
Practice Address - Street 2:NORTHSHORE CLINIC & CONSULTANTS INC
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090
Practice Address - Country:US
Practice Address - Phone:262-334-5323
Practice Address - Fax:262-334-4475
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2547-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional