Provider Demographics
NPI:1629535711
Name:REOPELLE, TARA JOLYNN (LICSW)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:JOLYNN
Last Name:REOPELLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7039 48TH ST N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-2649
Mailing Address - Country:US
Mailing Address - Phone:651-895-3289
Mailing Address - Fax:651-251-5204
Practice Address - Street 1:7066 STILLWATER BLVD N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-3937
Practice Address - Country:US
Practice Address - Phone:651-251-5139
Practice Address - Fax:651-251-5204
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN245731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical