Tara Prom's National Provider Identifier (NPI) Details
Tara Prom, LICSW
NPI: 1205338969
Enumeration Date: 2018-03-08
Last updated: 2018-03-08
Sole Proprietor: NO
Status: active
Postal Address: 1114 SOMERSET BLVD, SAINT CLOUD, MN
Phone: 320-266-0241
Primary Practice Address: 22 WILSON AVE NE SUITE 110, PO BOX 6069, SAINT CLOUD, MN
Practice's phone: 320-251-7700