Individual
JESSICA DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
619 W WALNUT ST, MILWAUKEE, WI 53212-3839
(414) 810-3548
(414) 810-3590
Mailing address
9000 W WISCONSIN AVE # MS 958, MILWAUKEE, WI 53226-4874
(414) 266-7615
(414) 266-6238
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5415-125
WI
101YP2500X
Professional Counselor
5415-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669872818
—
WI
Enumeration date
08/25/2014
Last updated
03/15/2024
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