Provider Demographics
NPI:1346223740
Name:OMAN, DIANE M (MS LCSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:OMAN
Suffix:
Gender:F
Credentials:MS LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 N GRAND AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4820
Mailing Address - Country:US
Mailing Address - Phone:262-547-2463
Mailing Address - Fax:262-547-8002
Practice Address - Street 1:741 N GRAND AVE
Practice Address - Street 2:STE 210
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4820
Practice Address - Country:US
Practice Address - Phone:262-547-2463
Practice Address - Fax:262-547-8002
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WI481125101YP2500X
WI16741231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39188900Medicaid