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DR. DIANE MARIE MOSNIK PH.D.

Clinical Neuropsychologist

Glendale, Wisconsin

Provider NPI: 1932146172

Provider Information:
DR. DIANE MARIE MOSNIK PH.D.
Gender: F
Not Sole Proprietor

Practice Location:
6110 N PORT WASHINGTON RD  GLENDALE, WI 53217 US
Tel: 414-962-1000  Fax: 414-963-6866

Business Mailing Address:
2357 E BENNETT AVE  MILWAUKEE, WI 53207 US
Tel: 832-483-9732  Fax: 414-963-6866

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
WI2620-057
N103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
TX31547

Other Provider Identifiers:

IssuerNumberStateType
Z000K3649TX05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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