Provider Demographics
NPI:1285240499
Name:TOLTZIEN, TINA (LCSW)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:TOLTZIEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2453 ATWOOD AVE STE 101A
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5655
Mailing Address - Country:US
Mailing Address - Phone:608-218-1533
Mailing Address - Fax:
Practice Address - Street 1:2453 ATWOOD AVE STE 101A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5655
Practice Address - Country:US
Practice Address - Phone:608-692-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI115101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty