Provider Demographics
NPI:1982207023
Name:TERI NUGENT PRIVATE PRACTICE, LLC
Entity Type:Organization
Organization Name:TERI NUGENT PRIVATE PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PRACTICE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:715-558-5377
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:STONE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54876-0188
Mailing Address - Country:US
Mailing Address - Phone:715-558-5377
Mailing Address - Fax:715-449-5475
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:715-449-5475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty