Provider Demographics
NPI:1639391030
Name:ZICK, TAMAR (MA LLC)
Entity Type:Individual
Prefix:MS
First Name:TAMAR
Middle Name:
Last Name:ZICK
Suffix:
Gender:F
Credentials:MA LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SOUTH BEDFORD STREET
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703
Mailing Address - Country:US
Mailing Address - Phone:608-256-6570
Mailing Address - Fax:608-256-4551
Practice Address - Street 1:222 SOUTH BEDFORD STREET
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703
Practice Address - Country:US
Practice Address - Phone:608-256-6570
Practice Address - Fax:608-256-4551
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3619125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39282100Medicaid