Individual
MELANIE DIDERIKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
576 LANKAMP ST NW, WALKER, MI 49544-1941
(269) 808-0255
Mailing address
225 N MICHIGAN AVE STE 1430, CHICAGO, IL 60601-7653
(312) 766-6780
(312) 261-5080
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6401014452
MI STATE LICENSE
MI
01
—
LPC013164
GA STATE LICENSE
GA
Enumeration date
08/08/2016
Last updated
11/16/2022
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