Provider Demographics
NPI:1619396454
Name:OLLMANN, TARA (MS)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:OLLMANN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2430 HWY 17
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-9452
Mailing Address - Country:US
Mailing Address - Phone:715-536-8016
Mailing Address - Fax:
Practice Address - Street 1:530 GRANT ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4738
Practice Address - Country:US
Practice Address - Phone:715-845-5493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2096-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional