Individual
DR. DIANE C GARRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
325 FOREST GROVE DR, SUITE 201, PEWAUKEE, WI 53072-3793
(262) 547-9673
(262) 549-5107
Mailing address
27100 WAUBEESEE LAKE DR, C/O KRISTY LAUX, WIND LAKE, WI 53185-2053
(262) 547-9673
(262) 549-5107
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
2274-057
WI
103TA0400X
Addiction (Substance Use Disorder) Psychologist
2274-057
WI
103TC0700X
Clinical Psychologist
Primary
2274-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39146400
—
WI
Enumeration date
01/03/2007
Last updated
07/18/2008
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