Healthcare Provider Details

I. General information

NPI: 1023627791
Provider Name (Legal Business Name): TARA C FISCHER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA C SEIDEL LPC

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S 6TH ST
DEPERE WI
54115-1214
US

IV. Provider business mailing address

PO BOX 309
SIREN WI
54872-0309
US

V. Phone/Fax

Practice location:
  • Phone: 920-336-8960
  • Fax: 833-581-5765
Mailing address:
  • Phone: 715-349-7069
  • Fax: 888-625-8634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7819-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: