Individual
DIEDRICH WASSERBAUER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7075 W BELL RD STE A-1, GLENDALE, AZ 85308-8546
(602) 488-6104
Mailing address
PO BOX 12468, GLENDALE, AZ 85318-2468
(602) 339-2457
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC-19445
AZ
Other
Enumeration date
03/25/2024
Last updated
03/17/2025
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