Individual
KELLIE ELAINE DEITRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
2155 E MAIN ST, REEDSBURG, WI 53959-9440
(608) 415-9956
Mailing address
800 MARY AVE, REEDSBURG, WI 53959-1119
(608) 415-7187
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
5124-226
WI
Other
Enumeration date
01/19/2022
Last updated
01/19/2022
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