Provider Demographics
NPI:1124861349
Name:GIARRUSSO, TALIA
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:GIARRUSSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 BROADWAY ST APT 41
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54015-9773
Mailing Address - Country:US
Mailing Address - Phone:715-323-5106
Mailing Address - Fax:
Practice Address - Street 1:1155 CENTRE POINTE DR STE 8
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55120-1278
Practice Address - Country:US
Practice Address - Phone:651-461-8033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical