Healthcare Provider Details

I. General information

NPI: 1649187410
Provider Name (Legal Business Name): TIERNEY CALLAHAN O'BRIEN MA, SSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

5000 N 53RD ST
MILWAUKEE WI
53218-4333
US

IV. Provider business mailing address

1132 S 3RD ST
MILWAUKEE WI
53204-2413
US

V. Phone/Fax

Practice location:
  • Phone: 414-393-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3001029046
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: