Individual
JERALD F TABBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSSW
Contact information
Practice address
123 16TH AVE S, ONALASKA, WI 54650-3109
(608) 775-8646
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16091-130
WI
1041C0700X
Clinical Social Worker
7590
WI
1041C0700X
Clinical Social Worker
Primary
7590-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40906100
—
WI
Enumeration date
01/17/2007
Last updated
04/22/2014
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