Individual
JONATHAN TALLAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2814 S 108TH ST, WEST ALLIS, WI 53227-3224
(414) 885-3525
(262) 643-4617
Mailing address
8444 N 90TH ST STE 100, SCOTTSDALE, AZ 85258-4437
(602) 248-8886
(480) 687-7361
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19776-130
WI
Other
Enumeration date
08/16/2022
Last updated
08/16/2022
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