Healthcare Provider Details

I. General information

NPI: 1851219745
Provider Name (Legal Business Name): TRAVIS J HARPER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 5TH AVE S STE 301
LA CROSSE WI
54601-4098
US

IV. Provider business mailing address

2600 N KIMBALL AVE APT 306
CHICAGO IL
60647-1237
US

V. Phone/Fax

Practice location:
  • Phone: 608-785-0827
  • Fax:
Mailing address:
  • Phone: 608-785-0827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136277
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: