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NPI Code Detail

MEDICARE: TARA OLLMANN MS

MEDICARE: TARA OLLMANN MS
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
1101YP2500XProfessional Counselor2096-226WI

General Provider Information

NPI Number : 1619396454
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA OLLMANN MS
Provider Business Mailing Address
First Line : N2430 HWY 17
Second Line :
City : MERRILL
State : WI
Zip : 54452-9452
Country : US
Telephone Number : 715-536-8016
Fax Number :
Provider Business Practice Location Address
First Line : 530 GRANT ST
Second Line :
City : WAUSAU
State : WI
Zip : 54403-4738
Country : US
Telephone Number : 715-845-5493
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2014
Last Update Date : 04/09/2014

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Directions to “ TARA OLLMANN MS” Practice Location

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