Tara M Prom, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

17338 Issued in MN

Practice address

22 Wilson Ave NE Suite 110
PO Box 6069
Saint Cloud, MN 56302-6069

Phone

(320) 251-7700

Fax

(320) 251-8898

NPI assigned

Mar 8, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Tara M Schloe Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520467200000",
    "number": "1205338969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1114 SOMERSET BLVD",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563030750",
            "telephone_number": "320-266-0241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 WILSON AVE NE SUITE 110",
            "address_2": "PO BOX 6069",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563026069",
            "telephone_number": "320-251-7700",
            "fax_number": "320-251-8898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROM",
        "first_name": "TARA",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-08",
        "last_updated": "2018-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "17338",
            "primary": true
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "MN",
            "license": "429597",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "SCHLOE",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Donald M. Primley, D.D.S., M.S.
• Danita Marie Primus, PHARMD
• Professional Hearing & Audiology Services, Inc.
• Profound Therapy LLC
• Project Battle Buddy
• Protea Health LLC
• Haley Prow
• Joy Prow, RBT
• Psychotherapeutic Resources LLP
• John Charles Pucel, PH.D

• Clinical Social Worker in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.