Individual
STEPHANI DIAGNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12225 71ST ST, KENOSHA, WI 53142-7320
(262) 948-4870
Mailing address
12225 71ST ST, KENOSHA, WI 53142-7320
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8777-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100211189
—
WI
Enumeration date
08/08/2022
Last updated
01/31/2025
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