Individual
CARLY DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
99 E 86TH AVE STE F, MERRILLVILLE, IN 46410-6267
(219) 616-4612
Mailing address
11160 STATE ST, CROWN POINT, IN 46307-8608
(219) 616-4612
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-42703
IN
103K00000X
Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
06/07/2018
Last updated
08/19/2025
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