Individual
DIANE CAROL DERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA ED.
Contact information
Practice address
2111 E BASELINE RD, TEMPE, AZ 85283-1516
(480) 489-3925
Mailing address
2111 E BASELINE RD, TEMPE, AZ 85283-1516
(480) 489-3925
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/11/2023
Last updated
05/11/2023
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