Provider Demographics
NPI:1609128263
Name:TIGGERUS, CONNOR ANDREW (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:CONNOR
Middle Name:ANDREW
Last Name:TIGGERUS
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1522
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54495-1522
Mailing Address - Country:US
Mailing Address - Phone:715-572-6017
Mailing Address - Fax:
Practice Address - Street 1:131 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PORT EDWARDS
Practice Address - State:WI
Practice Address - Zip Code:54469-1313
Practice Address - Country:US
Practice Address - Phone:715-572-6017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1516-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional