person
Wanda Diderich
Professional Counselor in Rockford, Illinois
NPI 1396259081

Wanda Diderich is a Professional Counselor based in Rockford, IL and is specialized in Professional. Wanda Diderich practices in Rockford, IL. The NPI Number for Wanda Diderich is 1396259081 and holds a License No. 178013374 (Illinois).

The current practice location address for Wanda Diderich is 8616 Northern Ave, Rockford, IL and can be reached out via phone at 815-332-8003 and via fax at 815-332-6090.

Location: 8616 Northern Ave, Rockford, IL, 61107-3877
person
Provider Profile Details
NPI Number
1396259081
Provider Name
Wanda Diderich
Credential
Provider Entity Type
Individual
Gender
Female
Address
8616 Northern Ave, Rockford, IL, 61107-3877
Phone Number
815-332-8003
Fax Number
815-332-6090
Provider Enumeration Date
11/17/2017
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
17013374 01 IL LPC
institution
Provider Business Practice Location Address Details
Address
8616 Northern Ave
City
State
Zip
61107-5309
Phone Number
815-332-8003
Fax Number
815-332-6090
person
Provider Business Mailing Address Details
Address
8616 Northern Ave
City
State
Zip
61107-5309
Phone Number
815-332-8003
Fax Number
815-332-6090
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
178013374 (Illinois)
Definition
Definition to come...
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