Healthcare Provider Details

I. General information

NPI: 1679582563
Provider Name (Legal Business Name): DEBORAH ANN CONTRERAS-TADYCH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4369 S HOWELL AVE STE 306
MILWAUKEE WI
53207-5055
US

IV. Provider business mailing address

1842 WELLSPRINGS CT
OCONOMOWOC WI
53066-4875
US

V. Phone/Fax

Practice location:
  • Phone: 414-999-0102
  • Fax:
Mailing address:
  • Phone: 414-899-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3288125
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2983-57
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3288
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: