Individual
KELLIE JEAN DIELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SAC-IT
Contact information
Practice address
459 E 1ST ST, FOND DU LAC, WI 54935-4505
(920) 920-3568
Mailing address
430 E DIVISION ST, FOND DU LAC, WI 54935-4560
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19064-130
WI
Other
Enumeration date
02/20/2020
Last updated
07/19/2024
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