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Individual

MS. DIANNE MARIE BENNETT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS LPC

Contact information

Practice address
1916 2ND ST W, MENOMONIE, WI 54751
(715) 308-1806
Mailing address
1916 2ND ST W, MENOMONIE, WI 54751
(715) 308-1806

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
2058132
WI
101YP2500X
Professional Counselor
Primary
1929125
WI

Other

Enumeration date
05/01/2008
Last updated
05/01/2008
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