Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 15964-132 | WI |
NPI | 1003245168 |
---|---|
Provider Name | Tiffany Schmit |
First Address | Montello, WI 53949-9248 |
Second Address | Montello, WI 53949-9248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2013 |
Last Update Date | 29/02/2016 |