Provider Demographics
NPI:1073096103
Name:RAYCHER, TRISTA HOLLY (MS)
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:HOLLY
Last Name:RAYCHER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8843 MANN RD
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:WI
Mailing Address - Zip Code:54493-8733
Mailing Address - Country:US
Mailing Address - Phone:715-937-5688
Mailing Address - Fax:
Practice Address - Street 1:106 GALVIN RD
Practice Address - Street 2:
Practice Address - City:ABBOTSFORD
Practice Address - State:WI
Practice Address - Zip Code:54405
Practice Address - Country:US
Practice Address - Phone:715-223-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)