Healthcare Provider Details

I. General information

NPI: 1447167101
Provider Name (Legal Business Name): TIFFANIE JEAN WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S CHERRY AVE STE 5
MARSHFIELD WI
54449-4263
US

IV. Provider business mailing address

1606 IMMANUEL CT
MARSHFIELD WI
54449-6018
US

V. Phone/Fax

Practice location:
  • Phone: 715-486-8302
  • Fax:
Mailing address:
  • Phone: 715-486-8302
  • Fax: 715-486-9253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number136376-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: