Diane M Moga-Roach, MSE, LCSW, LPC, CEAP

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

1849-125 Issued in WI

Practice address

2733 S Ridge Rd
Green Bay, WI 54304-5513

Phone

(920) 497-6200

Fax

(920) 497-3135

NPI assigned

Jan 31, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northeast Wisconsin Wellness Associates, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kaukauna, WI
  • NPI 1699530683
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1700923471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W5488 QUARRY RD",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549139790",
            "telephone_number": "920-739-2212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2733 S RIDGE RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045513",
            "telephone_number": "920-497-6200",
            "fax_number": "920-497-3135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOGA-ROACH",
        "first_name": "DIANE",
        "middle_name": "M",
        "credential": "MSE, LCSW, LPC, CEAP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "1849-125",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "3562-123",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39742500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Mocco, PT
• Melinda Modaff
• Modern Eyes LTD.
• Modern Hearing Solutions LLC (Modern Hearing)
• Gina M Moede, RADCI
• Yasir Yusuf Mohamed
• Ahmed Farouk Mohammed, MD
• Abdisamad Said Mohamud
• Brittany Anna Mohoney
• Wayne Steven Mohr, MD

• Professional Counselor in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.