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NPI Code Detail

MEDICARE: JESSICA DIAZ LPC

MEDICARE: JESSICA DIAZ LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor5415-125WI
2101YP2500XProfessional Counselor5415-125WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669872818
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA DIAZ LPC
Provider Business Mailing Address
First Line : 9000 W WISCONSIN AVE # MS 958
Second Line :
City : MILWAUKEE
State : WI
Zip : 53226-4874
Country : US
Telephone Number : 414-266-7615
Fax Number : 414-266-6238
Provider Business Practice Location Address
First Line : 619 W WALNUT ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-3839
Country : US
Telephone Number : 414-810-3548
Fax Number : 414-810-3590
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2014
Last Update Date : 03/15/2024

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Directions to “ JESSICA DIAZ LPC” Practice Location

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