Individual
LINDA M. TISO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, SAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12605-131
WI
1041C0700X
Clinical Social Worker
Primary
6969-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001084974
MEDICARE, ELKHORN PTAN
WI
05
—
40910600
—
WI
Enumeration date
07/20/2006
Last updated
05/26/2008
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