Provider Demographics
NPI:1891418794
Name:TARASEWICZ, DEAN PAUL
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:PAUL
Last Name:TARASEWICZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3261 BOND RD
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-2924
Mailing Address - Country:US
Mailing Address - Phone:715-563-0056
Mailing Address - Fax:
Practice Address - Street 1:428 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-5216
Practice Address - Country:US
Practice Address - Phone:507-454-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC03430101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health