Individual
MRS. SALLY SUE TARVID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
740 PILGRIM PKWY, SUITE 103, ELM GROVE, WI 53122-2067
(414) 491-0377
Mailing address
740 PILGRIM PKWY, SUITE 103, ELM GROVE, WI 53122-2067
(414) 491-0377
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7099123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40967200
—
WI
Enumeration date
09/20/2006
Last updated
01/28/2016
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