Provider Demographics
NPI:1851527428
Name:RULLMAN, TARA R (MA)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:R
Last Name:RULLMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:37790 89TH PL
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:53181-9168
Mailing Address - Country:US
Mailing Address - Phone:262-537-3877
Mailing Address - Fax:262-537-3718
Practice Address - Street 1:3734 7TH AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-5525
Practice Address - Country:US
Practice Address - Phone:262-654-9370
Practice Address - Fax:262-654-9379
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health