Individual
AMBER DIEDERICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC I, CRM
Contact information
Practice address
1501 6TH ST, LA GRANDE, OR 97850-2419
(541) 962-0162
Mailing address
1101 I AVE, LA GRANDE, OR 97850-2043
(541) 962-0162
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
17-06-28
OR
175T00000X
Peer Specialist
16-CRM-141
OR
Other
Enumeration date
08/09/2016
Last updated
07/18/2017
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