THEODORE J LAVAQUE Clinical Psychologist License verification

Business Entity

CANCELLED

License Type

Clinical Psychologist

Description

REGISTERED PSYCHOLOGIST

License Number

072001884

License Status

CANCELLED

Business

First Name

THEODORE J

Last Name

LAVAQUE

Business Name

THEODORE J LAVAQUE

Original Issue Date

06/26/1975

Expiration Date

09/30/1990

City

GREEN BAY

State

Zip

54301

County

WISCONSIN

Ever Disciplined

LastModifiedDate

09/04/2005