Provider Demographics
NPI:1811568876
Name:FITZGERALD, TARYN
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5066 W ASHLAND WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8177
Mailing Address - Country:US
Mailing Address - Phone:414-348-1354
Mailing Address - Fax:
Practice Address - Street 1:5066 W ASHLAND WAY
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8177
Practice Address - Country:US
Practice Address - Phone:414-348-1354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician