Provider Demographics
NPI:1003350422
Name:TOLEFREE, LA SHANDA (BA, MS)
Entity type:Individual
Prefix:
First Name:LA SHANDA
Middle Name:
Last Name:TOLEFREE
Suffix:
Gender:F
Credentials:BA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 52ND ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-2662
Mailing Address - Country:US
Mailing Address - Phone:262-842-0538
Mailing Address - Fax:262-842-0539
Practice Address - Street 1:3536 52ND ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-2662
Practice Address - Country:US
Practice Address - Phone:262-842-0538
Practice Address - Fax:262-842-0539
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17018131101YA0400X
WI8095-125101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100227567Medicaid
WI17018131OtherSUBSTANCE ABUSE COUNSELOR
WI8095125OtherLICENSED PROFESSIONAL COUNSELOR