Provider Demographics
NPI:1932117488
Name:SAVIDES, DIANE M (MSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:M
Last Name:SAVIDES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3076 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-6615
Mailing Address - Country:US
Mailing Address - Phone:920-261-4100
Mailing Address - Fax:920-261-8801
Practice Address - Street 1:1315 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094
Practice Address - Country:US
Practice Address - Phone:920-261-4100
Practice Address - Fax:920-261-8801
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI68361231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1024832OtherPHYSICIAN PLUS INS
WI268978OtherMHN INSURANCE
WI39785900H0Medicaid
6288615OtherUNITED BEHAVIORAL HEALTH
WI39184249620OtherUNITY INSURANCE WATERTOWN
WI39184249621OtherUNITY INSURANCE LAKE MILL
WI11994OtherDEON HEALTH INS
39184249609OtherJOHN DEERE HEALTH