Most Relevant Information
Provider Data
| NPI Number: | 1003350422 |
| Provider Name: | LA SHANDA TOLEFREE BA, MS |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 17018131 |
Most Important Dates
| Enumeration Date: | 12/05/2016 |
| Last Updated: | 05/14/2024 |
Provider Practice Location
3536 52ND ST
KENOSHA
WI
531442662
Practice Location Phone/Fax
| Phone: | 2628420538 |
| Fax: | 2628420539 |
Provider Mailing Location
3536 52ND ST
KENOSHA
WI
531442662
Provider Mailing Phone/Fax
| Phone: | 2628420538 |
| Fax: | 2628420539 |