Provider Demographics
NPI:1841939303
Name:STEVENSON, TESSA LEONE (MS)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:LEONE
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:LEONE
Other - Last Name:MISKIMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1219 N CASS ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2770
Mailing Address - Country:US
Mailing Address - Phone:608-228-9749
Mailing Address - Fax:
Practice Address - Street 1:1219 N CASS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2770
Practice Address - Country:US
Practice Address - Phone:608-228-9749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WI10779125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty