Provider Demographics
NPI:1841004108
Name:TETTEH, SETH KWESI
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:KWESI
Last Name:TETTEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SETH
Other - Middle Name:
Other - Last Name:TETTEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6602 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-4911
Mailing Address - Country:US
Mailing Address - Phone:512-985-4042
Mailing Address - Fax:
Practice Address - Street 1:6602 15TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-4911
Practice Address - Country:US
Practice Address - Phone:512-985-4042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8277226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health