Individual
CARISSA LYN DIETZLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
6001 RESEARCH PARK BLVD, MADISON, WI 53719-1176
(608) 263-6100
(608) 262-9246
Mailing address
6001 RESEARCH PARK BLVD, MADISON, WI 53719-1176
(608) 263-6100
(608) 262-9246
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5422
WI
Other
Enumeration date
10/28/2009
Last updated
02/23/2017
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