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General NPI Number Information
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NPI Number | 1780960575
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Entity Type | Individual
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Provider Name | TARA ELIZABETH ANDERSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 212 11TH ST S
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City | LA CROSSE
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State | WI
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Zip | 54601-4397
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Country | US
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Telephone | 608-392-9555
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1510
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City | EAU CLAIRE
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State | WI
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Zip | 54702-1510
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Country | US
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Telephone | 608-785-0940
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 23328
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.012808
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8160-123
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License Number State | WI
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