Individual
DIANE COOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12489 STATE HIGHWAY 56, VIOLA, WI 54664-8914
(608) 538-3781
(608) 538-3782
Mailing address
17969 WILSON SPRINGS RD, RICHLAND CENTER, WI 53581-8588
(608) 538-3781
(608) 538-3782
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/23/2016
Last updated
02/23/2016
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