Provider Demographics
NPI:1427322759
Name:DIECKMAN, ABBEY J (CSAC)
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:J
Last Name:DIECKMAN
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:ABBEY
Other - Middle Name:J
Other - Last Name:LANCASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, CSAC, ICS
Mailing Address - Street 1:406 TECHNOLOGY DR E STE B
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2768
Mailing Address - Country:US
Mailing Address - Phone:715-235-4696
Mailing Address - Fax:
Practice Address - Street 1:108 W 2ND ST N
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1338
Practice Address - Country:US
Practice Address - Phone:715-532-9771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15735-131101YA0400X
WI15717-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1427322759OtherDEANHEALTH PLAN
WI1427322759Medicaid
WIMALOMABBOtherMERCYCARE INSURANCE
WI1427322759OtherBCBSWI