Individual
MARY DIANE WIATROWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
404 N MAIN ST STE 612, OSHKOSH, WI 54901-4953
(920) 385-1420
(866) 327-3295
Mailing address
1020 W 5TH AVE, OSHKOSH, WI 54902-5728
(920) 410-7156
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
4176-123
WI
Other
Enumeration date
09/19/2017
Last updated
07/11/2018
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