Individual
THOMAS DIEDEN ACKERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
2925 MONDOVI RD, EAU CLAIRE, WI 54701-6141
(715) 832-0238
(715) 832-0771
Mailing address
N4382 TUCKER WAY DR, BLACK RIVER FALLS, WI 54615-6644
(715) 284-0972
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6547-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105505
SECURITY HEALTH PLAN #
WI
05
—
39759400
—
WI
01
—
6547-123
STATE MSW LICENSE #
WI
Enumeration date
11/15/2006
Last updated
07/09/2007
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