Provider Demographics
NPI:1891171732
Name:CAZZOLA, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:CAZZOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 LILAC LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140-1118
Mailing Address - Country:US
Mailing Address - Phone:920-540-0772
Mailing Address - Fax:
Practice Address - Street 1:2323 W EVERETT ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-4749
Practice Address - Country:US
Practice Address - Phone:920-560-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)