Provider Demographics
NPI:1427307750
Name:TISCHMAN, CORY D
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:D
Last Name:TISCHMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 HIGHLAND AVE STE O
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4389
Mailing Address - Country:US
Mailing Address - Phone:715-255-1117
Mailing Address - Fax:320-640-9261
Practice Address - Street 1:2004 HIGHLAND AVE STE O
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4389
Practice Address - Country:US
Practice Address - Phone:715-255-1117
Practice Address - Fax:320-640-9261
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI987-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist