Provider Demographics
NPI:1760601736
Name:TANNER, CHRISTIE (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:
Last Name:TANNER
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:DR
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:FELIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, LP
Mailing Address - Street 1:4330 GOLF TER
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4683
Mailing Address - Country:US
Mailing Address - Phone:715-828-1611
Mailing Address - Fax:715-833-2131
Practice Address - Street 1:4330 GOLF TER
Practice Address - Street 2:SUITE 203
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4683
Practice Address - Country:US
Practice Address - Phone:715-828-1611
Practice Address - Fax:715-833-2131
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2375-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical