Provider Demographics
NPI:1124852363
Name:TABOLICH, VICTORIA (MS)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:TABOLICH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 TOWER DR W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7609
Mailing Address - Country:US
Mailing Address - Phone:651-390-5001
Mailing Address - Fax:651-390-5002
Practice Address - Street 1:1715 TOWER DR W
Practice Address - Street 2:SUITE 100
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-7609
Practice Address - Country:US
Practice Address - Phone:651-390-5001
Practice Address - Fax:651-390-5002
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional