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Individual
TED D IZYDOR
Active
Individual
TED D IZYDOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
14034-132
WI
101YP2500X
Professional Counselor
Primary
2878
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275501140
—
WI
Enumeration date
03/08/2006
Last updated
10/21/2011
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