Individual
GRETCHEN A DIEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
700 RAYOVAC DRIVE, SUITE 311, MADISON, WI 53711-2476
(608) 492-0053
Mailing address
700 RAYOVAC DRIVE, SUITE 311, MADISON, WI 53711-2476
(608) 492-0053
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2591-57
WI
103T00000X
Psychologist
PSY19404
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2591-57
PSYCH
WI
01
—
PSY19404
PSYCH
CA
Enumeration date
07/18/2006
Last updated
04/08/2021
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