person
Ms. Ellen Mary Diedrich, LPC
Professional Counselor in Greenfield, Wisconsin
NPI 1477646727

Ellen Mary Diedrich is a Professional Counselor based in Greenfield, WI and is specialized in Professional. Ellen Mary Diedrich practices in Greenfield, WI and has the professional credentials of LPC. The NPI Number for Ellen Mary Diedrich is 1477646727 and holds a License No. 1927 (Wisconsin).

The current practice location address for Ellen Mary Diedrich is 4402 S 68Th St Ste 102, Greenfield, WI and can be reached out via phone at 414-585-9881 and via fax at 414-585-9867. You can also correspond with Ellen Mary Diedrich through the mailing address at 4402 S 68TH ST STE 102, GREENFIELD, WI - 53220-3479 (mailing address contact number: 414-585-9881).

Location: 4402 S 68Th St Ste 102, Greenfield, WI, 53220-3479
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Provider Profile Details
NPI Number
1477646727
Provider Name
Ellen Mary Diedrich
Credential
LPC
Provider Entity Type
Individual
Gender
Female
Address
4402 S 68Th St Ste 102, Greenfield, WI, 53220-3479
Phone Number
414-585-9881
Fax Number
414-585-9867
Provider Enumeration Date
10/01/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
20-2887407 01 WI TAX ID #
39686300 05 WI
institution
Provider Business Practice Location Address Details
Address
4402 S 68Th St Ste 102
City
State
Zip
53220-3479
Phone Number
414-585-9881
Fax Number
414-585-9867
person
Provider Business Mailing Address Details
Address
4402 S 68Th St Ste 102
City
State
Zip
53220-3479
Phone Number
414-585-9881
Fax Number
414-585-9867
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
2532-125 (Wisconsin)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
33-036 (Wisconsin)
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
1927 (Wisconsin)
Definition
Definition to come...
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