Individual
MS. DIANA LYNN BOLMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CSAC
Contact information
Practice address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 454-6502
(414) 454-6751
Mailing address
1220 DEWEY AVE, WAUWATOSA, WI 53213-2504
(414) 454-6502
(414) 454-6751
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11208
WI
1041C0700X
Clinical Social Worker
Primary
7030-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40919900
—
WI
Enumeration date
07/29/2006
Last updated
11/24/2021
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