Provider Demographics
NPI:1558741645
Name:LILJEBERG, TARAH LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:LYNN
Last Name:LILJEBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TARAH
Other - Middle Name:LYNN
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 381
Mailing Address - Street 2:
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-0381
Mailing Address - Country:US
Mailing Address - Phone:715-349-8913
Mailing Address - Fax:715-349-8981
Practice Address - Street 1:24178 FIRST AVE., STE 2
Practice Address - Street 2:
Practice Address - City:SIREN
Practice Address - State:WI
Practice Address - Zip Code:54872-0381
Practice Address - Country:US
Practice Address - Phone:715-349-8913
Practice Address - Fax:715-349-8913
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical