Individual
JODY DIANE DIETSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
327 E WAYNE ST STE 100, FORT WAYNE, IN 46802-2700
(260) 786-5865
(260) 676-4686
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34004929A
IN
Other
Enumeration date
07/25/2012
Last updated
09/13/2021
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