Vodicka, Diana M

Vodicka, Diana M is an individual health care provider with primary practice located at 1190 E Paradise Dr , West Bend WI 53095-5444. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Vodicka, Diana M can be contacted via phone (262) 306-6319.

Contact Information

Primary practice address
1190 E Paradise Dr West Bend WI 53095-5444
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X 220 Wisconsin

Profile Details

NPI number 1306036116
LBN Legal business name Vodicka, Diana M
Credentials MS CCC/SLP
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2007
Last updated Dec 5th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306036116 NPPES
Wisconsin MEDICAID 42670600

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