Individual
NANCI G DIERAUER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2248 S 102ND ST. #155, WEST ALLIS, WI 53227-2147
(414) 541-5100
(844) 515-9455
Mailing address
W359N5226 CRESTVIEW DR, OCONOMOWOC, WI 53066-3225
(262) 347-7585
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
3317-226
WI
101YP2500X
Professional Counselor
Primary
7492-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100071837
—
WI
Enumeration date
10/02/2017
Last updated
09/30/2021
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