Provider Demographics
NPI:1184701088
Name:KING, TEJUANA L (MSW, LCSW, CSAC)
Entity type:Individual
Prefix:
First Name:TEJUANA
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:MSW, LCSW, CSAC
Other - Prefix:
Other - First Name:TEJUANA
Other - Middle Name:L
Other - Last Name:LIPSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1126 S. 70TH STREET
Mailing Address - Street 2:SUITE S-507
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214
Mailing Address - Country:US
Mailing Address - Phone:414-727-2789
Mailing Address - Fax:414-476-8695
Practice Address - Street 1:1126 S. 70TH STREET
Practice Address - Street 2:SUITE S-507
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214
Practice Address - Country:US
Practice Address - Phone:414-727-2789
Practice Address - Fax:414-476-8695
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13881-132101YA0400X
WI7256-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40976800Medicaid