Provider Demographics
NPI:1568986636
Name:RONEY, DIA AUSTINE MAJETT
Entity Type:Individual
Prefix:
First Name:DIA AUSTINE
Middle Name:MAJETT
Last Name:RONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6627 WOLF HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:WI
Mailing Address - Zip Code:53598-9813
Mailing Address - Country:US
Mailing Address - Phone:913-293-9775
Mailing Address - Fax:
Practice Address - Street 1:6502 GRAND TETON PLZ STE 102
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719
Practice Address - Country:US
Practice Address - Phone:913-293-9775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013919101YM0800X
WI7424-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health