MEDICARE: DIANA MIGACZ 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
1	101YP2500X	Professional Counselor	4355-226	WI

General Provider Information

NPI Number	:	1164990750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA MIGACZ LPC

Provider Business Mailing Address
First Line	:	W175N11120 STONEWOOD DR
Second Line	:
City	:	GERMANTOWN
State	:	WI
Zip	:	53022-4799
Country	:	US
Telephone Number	:	888-468-5952
Fax Number	:	262-345-5562

Provider Business Practice Location Address
First Line	:	830 N 19TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-1616
Country	:	US
Telephone Number	:	800-438-1772
Fax Number	:	262-345-5562

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2018
Last Update Date	:	04/29/2025

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