Provider Demographics
NPI:1861635393
Name:TAFFE, DENNIS ROBERT (LADC)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:ROBERT
Last Name:TAFFE
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 ATLANTIC AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MORRIS
Mailing Address - State:MN
Mailing Address - Zip Code:56267
Mailing Address - Country:US
Mailing Address - Phone:320-585-6180
Mailing Address - Fax:320-585-6182
Practice Address - Street 1:712 ATLANTIC AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267
Practice Address - Country:US
Practice Address - Phone:320-585-6180
Practice Address - Fax:320-585-6182
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)