Provider Demographics
NPI:1598488991
Name:DAMROW, TANYA MARIE (MA SAC LPC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:DAMROW
Suffix:
Gender:F
Credentials:MA SAC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3111
Mailing Address - Country:US
Mailing Address - Phone:920-453-3557
Mailing Address - Fax:920-453-3901
Practice Address - Street 1:1221 N 26TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3111
Practice Address - Country:US
Practice Address - Phone:920-453-3557
Practice Address - Fax:920-453-3901
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7984-125101YM0800X
WI16183101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health