Provider Demographics
NPI:1417017898
Name:DIEKHANS, WANDA SUE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:SUE
Last Name:DIEKHANS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 905
Mailing Address - Street 2:
Mailing Address - City:FORT BENTON
Mailing Address - State:MT
Mailing Address - Zip Code:59442
Mailing Address - Country:US
Mailing Address - Phone:406-788-6574
Mailing Address - Fax:406-727-3799
Practice Address - Street 1:1108 FRANKLIN
Practice Address - Street 2:
Practice Address - City:FORT BENTON
Practice Address - State:MT
Practice Address - Zip Code:59442
Practice Address - Country:US
Practice Address - Phone:406-788-6574
Practice Address - Fax:406-727-3791
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCPC 994101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT745473OtherBCBS
MT254473Medicaid
MT745473OtherTRICARE