Basic Information
| Provider Information | |||||||||
| NPI: | 1891418794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TARASEWICZ | ||||||||
| FirstName: | DEAN | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | N3261 BOND RD | ||||||||
| Address2: | |||||||||
| City: | LA CROSSE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546012924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155630056 | ||||||||
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| Practice Location | |||||||||
| Address1: | 428 W BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | WINONA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559875216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5074547711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2022 | ||||||||
| LastUpdateDate: | 09/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CC03430 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.