Individual
KELSY DIETERICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CST/CSFA
Contact information
Practice address
5100 FRANKLIN AVE STE C, WACO, TX 76710-6922
(254) 754-0375
(254) 754-2667
Mailing address
5100 FRANKLIN AVE STE C, WACO, TX 76710-6922
(254) 754-0375
(254) 754-2667
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
178624
TX
Other
Enumeration date
05/25/2018
Last updated
05/25/2018
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