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NPI Code Detail

MEDICARE: JULIANNA MARIE TAVALE MSW LCSW

MEDICARE: JULIANNA MARIE TAVALE MSW LCSW
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerWI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
115953438OTHERCAQH
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336824457
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIANNA MARIE TAVALE MSW LCSW
Provider Business Mailing Address
First Line : 3001 US HIGHWAY 12 E STE 160
Second Line :
City : MENOMONIE
State : WI
Zip : 54751-3045
Country : US
Telephone Number : 715-232-1116
Fax Number : 715-232-5987
Provider Business Practice Location Address
First Line : 3001 US HIGHWAY 12 E STE 160
Second Line :
City : MENOMONIE
State : WI
Zip : 54751-3045
Country : US
Telephone Number : 715-232-1116
Fax Number : 715-232-5987
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2023
Last Update Date : 06/10/2026

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