Individual
DIANA JODI FREDERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
57 W CALLE LA BOLITA, SAHUARITA, AZ 85629-8663
(520) 743-6640
Mailing address
57 W CALLE LA BOLITA, SAHUARITA, AZ 85629-8663
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12321
AZ
Other
Enumeration date
12/17/2007
Last updated
04/06/2012
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