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General NPI Number Information
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NPI Number | 1609128263
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Entity Type | Individual
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Provider Name | CONNOR ANDREW TIGGERUS M.S., LPC
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Gender | Male
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | 131 WASHINGTON AVE
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City | PORT EDWARDS
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State | WI
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Zip | 54469-1313
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Country | US
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Telephone | 715-572-6017
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1522
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54495-1522
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Country | US
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Telephone | 715-572-6017
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1516-226
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License Number State | WI
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