Provider Demographics
NPI:1770223216
Name:WALTER, TANYA (LPC, SAC-IT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:LPC, SAC-IT
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:RIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, SAC-IT
Mailing Address - Street 1:721 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5212
Mailing Address - Country:US
Mailing Address - Phone:715-839-7602
Mailing Address - Fax:
Practice Address - Street 1:721 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5212
Practice Address - Country:US
Practice Address - Phone:715-839-7602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20227101YA0400X
WI8452101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)