| Doctor Name: | LINDA M. TISO |
| NPI Number: | 1013937341 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LCSW, SAC |
| License Number: | 12605-131 |
| Business Practice Address: | 3535 30th Ave Suite 202 Kenosha, WI - 531441632 |
| Business Phone Number: | 2628420500 |
| Business Fax Number: | 2628420502 |
| Mailing Address: | 285 N Janacek Rd, BROOKFIELD |
| State: | WI |
| Postal Code: | 530456102 |
| Phone Number: | 2626419050 |
| Fax Number: | 2626419126 |
| NPI Enumeration Date: | 07/20/2006 |
| NPI Last Update Date: | 05/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 12605-131 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |