Individual
MARY J LANDKAMER-TAGATZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
161 SPRING ST, WESTFIELD, WI 53964-9068
(608) 296-2139
Mailing address
161 SPRING ST, WESTFIELD, WI 53964-9068
(608) 296-2139
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1634 - 123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39675300
—
WI
Enumeration date
05/09/2008
Last updated
05/09/2008
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