Individual
MELANIE DIERICKX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
218 1/2 N 2ND ST, ELDRIDGE, IA 52748-1208
(563) 676-2357
Mailing address
415 E GEORGE WASHINGTON BLVD, DAVENPORT, IA 52803-1230
(563) 676-2357
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
099976
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
099976
BOARD OF SOCIAL WORK LICENSE
IA
Enumeration date
06/22/2020
Last updated
06/22/2020
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