MRS. SUZETTE CAROLYN-EVE DIEDERICH (NPI# 1609972280) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609972280 |
| Entity Type | Individual |
| Full Name | MRS. SUZETTE CAROLYN-EVE DIEDERICH |
| Credential | M.S. ED., L.P.C. |
| Practice Address |
3867 Robin Ln Green Bay WI 54313-4601 |
| Practice Telephone | 9208654399 |
| Practice Fax Number | 9208654399 |
| Mailing Telephone | 9208654399 |
| Mailing Fax Number | 9208654399 |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2007-07-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 101Y00000X | Counselor | 3387-125 | WI | Behavioral Health & Social Service Providers |
| X | 101YM0800X |
Counselor Specialization: Mental Health |
3387-125 | WI | Behavioral Health & Social Service Providers |
| X | 101YP2500X |
Counselor Specialization: Professional |
3387-125 | WI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | LICENSED PROFESSIONAL COU | 3387-125 | 01 |
| WI | 40967700 31/708 | 05 |
| Street Address |
3867 ROBIN LN |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54313-4601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548823420 | Martha Lynn Drew | Licensed Practical Nurse | 3101 Molly Brown Lane, Green Day, WI 54313 | 2019-04-17 |
| 1831691872 | Melanie Hammerbeck | Dentist | 1756 Cardinal Ln, Green Bay, WI 54313 | 2018-03-06 |
| 1649727108 | Amanda Marie Mckeefry | Dental Hygienist | 2304 Lineville Rd, Suite 101, Green Bay, WI 54313 | 2016-09-01 |
| 1326594813 | Kaylee Schartner | Dental Hygienist | 2304 Lineville Road, Suite 100, Suamico, WI 54313 | 2016-08-25 |
| 1134500226 | Salvanz Enterprises Inc | Pharmacy | 2673 Lineville Road, Green Bay, WI 54313 | 2015-06-15 |
| 1467849307 | Maureen Riordan | Specialist/Technologist | 2957 S Telemark Cir., Green Bay, WI 54313 | 2015-04-17 |
| 1043556780 | Kellen James Binder | Chiropractor | 2638 Tulip Lane, Suite B, Green Bay, WI 54313 | 2012-12-28 |
| 1407092737 | Sara Ann Anderson | Registered Nurse | 2691 Shade Tree Ln, Green Bay, WI 54313 | 2008-12-16 |
| 1467601344 | Melissa Lea Socha | Speech-Language Pathologist | 2153 School Lane, Suamiro Elementary, Green Bay, WI 54313 | 2008-09-16 |
| 1003070707 | Anne Marie Hein | Physical Therapist | 3101 S Packerland Dr, Green Bay, WI 54313 | 2008-07-11 |
| Find all providers in zip 54313 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902437932 | Amanda Kay Harpt | Counselor | 516 Hilltop Dr, Green Bay, WI 54301-2718 | 2020-01-29 |
| 1649825159 | Ashley L Scott | Counselor | 416 Crooks St, Green Bay, WI 54301-4529 | 2019-08-02 |
| 1215291950 | Kristine Kay Sack | Counselor | 926 Willard Drive, Ste 136, Green Bay, WI 54304-5071 | 2012-06-27 |
| 1184717092 | Catherine S.c. Mackenzie | Counselor | 444 South Adams St, Suite 6, Green Bay, WI 54301 | 2006-10-02 |
| 1730272642 | Julie Ann Kruk | Counselor | 444 South Adams St., Suite 6, Green Bay, WI 54301 | 2006-10-02 |
| 1013562230 | Sara Noel Wisneski | Counselor | 1061 W Mason St, Green Bay, WI 54303-1858 | 2019-08-05 |
| 1821568437 | John R Cheslock | Counselor | 626 S Irwin Ave, Green Bay, WI 54301-3304 | 2018-11-27 |
| 1164952933 | Rebecca Lou Rauens | Counselor | 1499 6th St, Green Bay, WI 54304-2252 | 2017-06-14 |
| 1932642592 | Stacie M Koskinen | Counselor | 300 Crooks St, Green Bay, WI 54301-4527 | 2016-11-29 |
| 1477908812 | Samantha Jane Mckenzie | Counselor | 1039 W Mason St, Green Bay, WI 54303-1842 | 2016-05-03 |
| Find all providers in GREEN BAY | ||||
Please comment or provide details below to improve the information on MRS. SUZETTE CAROLYN-EVE DIEDERICH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.