Diedrich, Ellen Mary

Diedrich, Ellen Mary is an sole proprietor health care provider with primary practice located at 4402 S 68Th St Ste 102 , Greenfield WI 53220-3479. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Diedrich, Ellen Mary can be contacted via phone (414) 585-9881.

Contact Information

Primary practice address
4402 S 68Th St Ste 102 Greenfield WI 53220-3479
Phone: (414) 585-9881
Fax: (414) 585-9867
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 1927 Wisconsin
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 33-036 Wisconsin
Behavioral Health & Social Service Providers / Professional 101YP2500X 2532-125 Wisconsin

Profile Details

NPI number 1477646727
LBN Legal business name Diedrich, Ellen Mary
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 1st, 2006
Last updated Aug 29th, 2016 - about 8 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 1477646727 NPPES
Wisconsin Other 20-2887407 TAX ID #
Wisconsin MEDICAID 39686300 TAX ID #

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