Individual
TARA L ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS.,PSYD
Contact information
Practice address
301 E SAINT JOSEPH ST, GREEN BAY, WI 54301-2241
(920) 433-3630
Mailing address
301 E SAINT JOSEPH ST, GREEN BAY, WI 54301-2241
(920) 433-3630
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2750
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831229376
—
WI
05
—
43596700
—
WI
Enumeration date
03/06/2007
Last updated
02/10/2021
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