Healthcare Provider Details

I. General information

NPI: 1447584339
Provider Name (Legal Business Name): DENISE MARIE DILL MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 SOUTH 8TH STREET
MANITOWOC WI
54220
US

IV. Provider business mailing address

N743 COUNTY ROAD J
NEW HOLSTEIN WI
53061-9742
US

V. Phone/Fax

Practice location:
  • Phone: 920-683-4922
  • Fax:
Mailing address:
  • Phone: 920-418-0818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: