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General NPI Number Information
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NPI Number | 1891418794
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Entity Type | Individual
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Provider Name | MR. DEAN PAUL TARASEWICZ
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Gender | Male
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 428 W BROADWAY ST
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City | WINONA
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State | MN
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Zip | 55987-5216
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Country | US
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Telephone | 507-454-7711
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Fax |
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Provider Business Mailing Address
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Address Line | N3261 BOND RD
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City | LA CROSSE
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State | WI
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Zip | 54601-2924
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Country | US
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Telephone | 715-563-0056
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CC03430
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License Number State | MN
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