Healthcare Provider Details

I. General information

NPI: 1316580418
Provider Name (Legal Business Name): TRIQUESTRIAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 ENTERPRISE LN STE 210
MADISON WI
53719-1143
US

IV. Provider business mailing address

1408 ASHBURN WAY
VERONA WI
53593-2263
US

V. Phone/Fax

Practice location:
  • Phone: 608-400-3672
  • Fax: 608-422-4006
Mailing address:
  • Phone: 608-206-4724
  • Fax: 608-422-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TAMI RA BAHR
Title or Position: OWNER/DIRECTOR
Credential: LCSW, CSAC, ICS
Phone: 608-206-4724