Individual
MS. DIANA M STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
4089 COUNTY HWY N, COLFAX, WI 54730-2322
(715) 829-0391
Mailing address
4089 COUNTY HWY N, COLFAX, WI 54730-2322
(715) 829-0391
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
3574-123
WI
106H00000X
Marriage & Family Therapist
Primary
71-124
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15953
APPROVED SUPERVISOR
WI
05
—
39274200
—
WI
Enumeration date
11/14/2006
Last updated
03/26/2014
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