Diederich, Suzette Carolyn-Eve

Diederich, Suzette Carolyn-Eve is an sole proprietor health care provider with primary practice located at 123 N Oakland Ave , Green Bay WI 54303-2831. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Diederich, Suzette Carolyn-Eve can be contacted via phone (920) 770-4088.

Contact Information

Primary practice address
123 N Oakland Ave Green Bay WI 54303-2831
Phone: (920) 770-4088
Fax: (651) 705-0026
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 3387-125 Wisconsin
Behavioral Health & Social Service Providers / Professional 101YP2500X 3387-125 Wisconsin

Profile Details

NPI number 1609972280
LBN Legal business name Diederich, Suzette Carolyn-Eve
Credentials M.S. ED., L.P.C.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 15th, 2006
Last updated Jun 9th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609972280 NPPES
Wisconsin MEDICAID 40967700
Wisconsin Other 60291900 ID=7
Wisconsin Other 3387-125

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