Lisa Dedrick
Individual provider Active NPI Professional Counselor · Montello, WI
NPI 1417317751 · NPPES record last updated May 9, 2016
Key facts
- NPI
- 1417317751
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 2416-226 (WI)
- Practice address
- 480 Underwood Ave
Montello, WI 53949-9248 - Phone
- (608) 297-3181
- NPI assigned
- Feb 29, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2416-226 | WI | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2416-226 | WI | Yes |
Addresses
Primary practice location
480 Underwood Ave
Montello, WI 53949-9248
Mailing address
480 Underwood Ave
Montello, WI 53949-9248
Phone (608) 297-3181
Other providers in Montello, WI
- Mikayla Ann Breneman
- Mindy Kay Brown
- Community Health Network
- County of Marquette
- County of Marquette
- Timothy Michael Fischer
- William T Franks
- Maria Gambaro
- Michelle D. Green
- Shannon Stacey Harmon
All providers in Montello, WI · Professional Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.