| Doctor Name: | JODIE TIRADO |
| NPI Number: | 1174909378 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 17348-130 |
| Business Practice Address: | W9850 Airport Rd. Black River Falls, WI - 546150918 |
| Business Phone Number: | 7152849851 |
| Business Fax Number: | |
| Mailing Address: | Po Box 918, BLACK RIVER FALLS |
| State: | WI |
| Postal Code: | 546150918 |
| Phone Number: | 7152849851 |
| Fax Number: | |
| NPI Enumeration Date: | 08/11/2015 |
| NPI Last Update Date: | 08/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 17348-130 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |