Provider Demographics
NPI:1487200689
Name:JAMISON, TIA S
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:S
Last Name:JAMISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N 26TH ST APT 202
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2538
Mailing Address - Country:US
Mailing Address - Phone:262-309-9962
Mailing Address - Fax:
Practice Address - Street 1:505 N 26TH ST APT 202
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2538
Practice Address - Country:US
Practice Address - Phone:262-309-9962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst