Provider Demographics
NPI:1740995315
Name:TAME, BRENDA ALLISON (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ALLISON
Last Name:TAME
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W BEECH AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1204
Mailing Address - Country:US
Mailing Address - Phone:218-332-2018
Mailing Address - Fax:
Practice Address - Street 1:119 FRIBERG AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2306
Practice Address - Country:US
Practice Address - Phone:218-332-2018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31654104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker