Provider Demographics
NPI:1023266194
Name:HISER, TANYA KATHERINE CUTLER (MS, LPC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:KATHERINE CUTLER
Last Name:HISER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:KATHERINE
Other - Last Name:BAKKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:7109 BRINDLEY CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2128
Mailing Address - Country:US
Mailing Address - Phone:608-516-4347
Mailing Address - Fax:
Practice Address - Street 1:7109 BRINDLEY CIR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2128
Practice Address - Country:US
Practice Address - Phone:086-205-8650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3033125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43741200Medicaid