Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 13162-132 | WI |
Y | 103TC1900X | Counseling Psychologist |
NPI | 1003063090 |
---|---|
Provider Name | Dr. Tiffany Marie Prather |
First Address | Wauwatosa, WI 53222-2446 |
Second Address | Wauwatosa, WI 53222-2446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2008 |
Last Update Date | 21/08/2008 |