Provider Demographics
NPI:1467909630
Name:POLLARD, TIGE
Entity Type:Individual
Prefix:
First Name:TIGE
Middle Name:
Last Name:POLLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 MOLE AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-1435
Mailing Address - Country:US
Mailing Address - Phone:608-289-9541
Mailing Address - Fax:
Practice Address - Street 1:2012 MOLE AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-1435
Practice Address - Country:US
Practice Address - Phone:608-289-9541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional