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NPI Code Detail

MEDICARE: TARA NOTZKE

MEDICARE: TARA NOTZKE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor14008WI

General Provider Information

NPI Number : 1346397122
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA NOTZKE
Provider Business Mailing Address
First Line : PO BOX 8003
Second Line :
City : APPLETON
State : WI
Zip : 54912-8003
Country : US
Telephone Number : 920-996-3298
Fax Number :
Provider Business Practice Location Address
First Line : 1095 MIDWAY RD
Second Line :
City : MENASHA
State : WI
Zip : 54952-1115
Country : US
Telephone Number : 920-720-2300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2007
Last Update Date : 07/08/2007

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Directions to “ TARA NOTZKE ” Practice Location

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