Individual
DIANA M VODICKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC/SLP
Contact information
Practice address
1190 E PARADISE DR, WEST BEND, WI 53095-5444
(262) 306-6319
Mailing address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(262) 334-3451
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
220
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42670600
—
WI
Enumeration date
07/27/2007
Last updated
12/05/2012
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