Individual
MS. JEANETTE DIEDERICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSCSW
Contact information
Practice address
560 N EXPOSITION ST, WICHITA, KS 67203-5902
(316) 264-8317
Mailing address
4505 E 47TH ST S, WICHITA, KS 67210-1651
(316) 529-9100
(316) 529-9351
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5676
KS
Other
Enumeration date
08/06/2009
Last updated
11/23/2009
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