Individual
MS. ELLEN MARY DIEDRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
4402 S 68TH ST STE 102, GREENFIELD, WI 53220-3479
(414) 585-9881
(414) 585-9867
Mailing address
4402 S 68TH ST STE 102, GREENFIELD, WI 53220-3479
(414) 585-9881
(414) 585-9867
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1927
WI
101YM0800X
Mental Health Counselor
Primary
33-036
WI
101YP2500X
Professional Counselor
2532-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-2887407
TAX ID #
WI
05
—
39686300
—
WI
Enumeration date
10/01/2006
Last updated
08/29/2016
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