MEDICARE: TRIQUESTRIAN, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1316580418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIQUESTRIAN, LLC

Provider Business Mailing Address
First Line	:	1408 ASHBURN WAY
Second Line	:
City	:	VERONA
State	:	WI
Zip	:	53593-2263
Country	:	US
Telephone Number	:	608-206-4724
Fax Number	:	608-422-4006

Provider Business Practice Location Address
First Line	:	6410 ENTERPRISE LN STE 210
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-1143
Country	:	US
Telephone Number	:	608-400-3672
Fax Number	:	608-422-4006

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	TAMI RA BAHR
Credential	:	LCSW, CSAC, ICS
Telephone Number	:	608-206-4724

Provider Enumeration Date	:	10/21/2019
Last Update Date	:	01/19/2024

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Directions to “TRIQUESTRIAN, LLC ” Practice Location

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