Provider Demographics
NPI:1760868939
Name:SLEITER, TISHA DAWN (MSW, APSW)
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:DAWN
Last Name:SLEITER
Suffix:
Gender:F
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:WI
Mailing Address - Zip Code:54448-8800
Mailing Address - Country:US
Mailing Address - Phone:715-321-5444
Mailing Address - Fax:
Practice Address - Street 1:143 S GIBSON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1622
Practice Address - Country:US
Practice Address - Phone:715-748-2121
Practice Address - Fax:715-748-7595
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130572-121104100000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker