Individual
MRS. SUZETTE CAROLYN-EVE DIEDERICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. ED., L.P.C.
Contact information
Practice address
123 N OAKLAND AVE, GREEN BAY, WI 54303-2831
(920) 770-4088
(651) 705-0026
Mailing address
3645 WILDCAT TRL APT 3, NEW FRANKEN, WI 54229-9207
(920) 366-8590
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
3387-125
WI
101YP2500X
Professional Counselor
Primary
3387-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3387-125
LICENSED PROFESSIONAL COU
WI
05
—
40967700
—
WI
01
—
60291900 ID=7
EDI TRADING PARTNER NO.
WI
Enumeration date
09/15/2006
Last updated
06/09/2022
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