Individual
MRS. JAIME DIETZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2003 SE WALTON BLVD, BENTONVILLE, AR 72712-3725
(479) 464-5925
(479) 464-4275
Mailing address
2458 SISKIYOU ST, LEWISVILLE, TX 75056-6790
(972) 743-4416
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
60577
TX
Other
Enumeration date
08/18/2011
Last updated
07/13/2021
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