Moga-Roach, Diane M

Moga-Roach, Diane M is an individual health care provider with primary practice located at 2733 S Ridge Rd , Green Bay WI 54304-5513. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Professional is her primary health care specialty. Moga-Roach, Diane M can be contacted via phone (920) 497-6200.

Contact Information

Primary practice address
2733 S Ridge Rd Green Bay WI 54304-5513
Phone: (920) 497-6200
Fax: (920) 497-3135
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X 1849-125 Wisconsin
Behavioral Health & Social Service Providers / Clinical 1041C0700X 3562-123 Wisconsin

Profile Details

NPI number 1700923471
LBN Legal business name Moga-Roach, Diane M
Credentials MSE, LCSW, LPC, CEAP
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 31st, 2007
Last updated Jul 8th, 2007 - about 17 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 1700923471 NPPES
Wisconsin MEDICAID 39742500

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