Individual
TASHA FARRAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3301 N BALLARD RD STE C, APPLETON, WI 54911-9002
(920) 841-8326
Mailing address
402 E PACIFIC ST, APPLETON, WI 54911-5069
(802) 579-2252
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
042-0011157
VT
2084P0800X
Psychiatry Physician
042-0011157
VT
2084P0800X
Psychiatry Physician
Primary
54559-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042-0011157
STATE LICENSE
VT
01
—
54559-020
STATE LICENSE
WI
Enumeration date
07/04/2006
Last updated
02/12/2020
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