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General NPI Number Information
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NPI Number | 1912378530
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Entity Type | Individual
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Provider Name | IANSA TINKLE LPC, MT-BC
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Gender | Female
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 10/22/2019
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Provider Practice Location Address
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Address Line | 505 S DEWEY ST STE 208
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City | EAU CLAIRE
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State | WI
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Zip | 54701
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Country | US
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Telephone | 715-832-1678
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Fax | 715-832-6680
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Provider Business Mailing Address
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Address Line | 605 S DEWEY ST
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City | EAU CLAIRE
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State | WI
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Zip | 54701-3825
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Country | US
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Telephone |
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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 | 225A00000X
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Taxonomy Name | Music Therapist
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License Number | 10728
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7548-125
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License Number State | WI
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