Provider Demographics
NPI:1639804107
Name:CALLAHAN, TONYA LYN KRUEGER (MS CRC LPC)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:LYN KRUEGER
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:MS CRC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-6364
Mailing Address - Country:US
Mailing Address - Phone:715-570-8345
Mailing Address - Fax:
Practice Address - Street 1:1191 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-6364
Practice Address - Country:US
Practice Address - Phone:715-570-8345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16237225C00000X
WI3257-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor