Provider Demographics
NPI:1497292106
Name:STRONG, TONTIANA NICOLE (SAC)
Entity Type:Individual
Prefix:
First Name:TONTIANA
Middle Name:NICOLE
Last Name:STRONG
Suffix:
Gender:F
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-2780
Mailing Address - Country:US
Mailing Address - Phone:715-828-1313
Mailing Address - Fax:715-726-9055
Practice Address - Street 1:127 W CENTRAL ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-2346
Practice Address - Country:US
Practice Address - Phone:715-726-9023
Practice Address - Fax:715-726-9055
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15905-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI15905-131OtherSTATE OF WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES