Healthcare Provider Details

I. General information

NPI: 1952342347
Provider Name (Legal Business Name): DIANE MARIE CONTRERAS AU.D.,CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-3518
US

IV. Provider business mailing address

804 MINAKA DR
WAUKESHA WI
53188-5604
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-7674
  • Fax: 414-266-6189
Mailing address:
  • Phone: 262-522-9874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number382156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: