Provider Demographics
NPI:1689884686
Name:TIKKANEN, LARA SKYE (LPC, CSAC)
Entity Type:Individual
Prefix:MS
First Name:LARA
Middle Name:SKYE
Last Name:TIKKANEN
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 APPLEGATE ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3184
Mailing Address - Country:US
Mailing Address - Phone:608-221-1500
Mailing Address - Fax:608-221-1515
Practice Address - Street 1:6502 GRAND TETON PLZ STE 102
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1047
Practice Address - Country:US
Practice Address - Phone:608-827-7220
Practice Address - Fax:608-827-7223
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15459-1321041C0700X
WI5352-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI14277-130OtherSAC-IT
WI15459-132OtherCSAC
WI5352-125OtherLPC