Provider Demographics
NPI:1003658485
Name:DIETZ, VICTORIA ROSE (APSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ROSE
Last Name:DIETZ
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 S BUTLER ST STE 106
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-5606
Mailing Address - Country:US
Mailing Address - Phone:608-218-1440
Mailing Address - Fax:
Practice Address - Street 1:133 S BUTLER ST STE 106
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-5606
Practice Address - Country:US
Practice Address - Phone:608-218-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134900-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical