Individual
DEBRA DIETRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYCHOLOGIST
Contact information
Practice address
2404 E EMPIRE ST, BLOOMINGTON, IL 61704-3630
(309) 663-8275
(309) 687-2035
Mailing address
PO BOX 991, MORTON, IL 61550-0991
(309) 678-3155
(309) 672-6717
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
1062455
IL
Other
Enumeration date
06/05/2007
Last updated
07/08/2007
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