Provider Demographics
NPI:1316715782
Name:OSOWSKI, TARYN M
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:M
Last Name:OSOWSKI
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 1:3101 S FRONTAGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2545
Mailing Address - Country:US
Mailing Address - Phone:218-236-1494
Mailing Address - Fax:218-236-0836
Practice Address - Street 1:3101 S FRONTAGE RD STE 100
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2545
Practice Address - Country:US
Practice Address - Phone:218-236-1494
Practice Address - Fax:218-236-0836
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4241106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist