Individual
DR. DIANE MARIE MOSNIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
6110 N PORT WASHINGTON RD, GLENDALE, WI 53217-4308
(414) 962-1000
(414) 963-6866
Mailing address
2357 E BENNETT AVE, MILWAUKEE, WI 53207-2919
(832) 483-9732
(414) 963-6866
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
2620-057
WI
103G00000X
Clinical Neuropsychologist
31547
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z000K3649
—
TX
Enumeration date
05/31/2006
Last updated
01/20/2015
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