Individual
KELLY LEE DITTBERNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
215 NORTHRIDGE DR, PORTAGE, WI 53901-9294
(608) 516-9337
(608) 745-0333
Mailing address
W12250 HILLCREST DR, LODI, WI 53555-9329
(608) 516-9337
(608) 592-5818
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
05/10/2008
Last updated
05/10/2008
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