Individual
TAMARA MARIE DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSAC
Contact information
Practice address
400 W RIVER DR, WEST BEND, WI 53090-1567
(262) 338-2717
(262) 338-9767
Mailing address
400 W RIVER DR, WEST BEND, WI 53090-1567
(262) 338-2717
(262) 338-9767
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15350-132
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39179600
—
WI
Enumeration date
09/11/2007
Last updated
12/28/2009
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