| Doctor Name: | MARCIA C DIEDERICH |
| NPI Number: | 1003067919 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 4074924 |
| Business Practice Address: | 25250 N 35th Ave Phoenix, AZ - 850834335 |
| Business Phone Number: | 6234457100 |
| Business Fax Number: | 6234457180 |
| Mailing Address: | 25250 N 35th Ave, PHOENIX |
| State: | AZ |
| Postal Code: | 850834335 |
| Phone Number: | 6234457100 |
| Fax Number: | 6234457180 |
| NPI Enumeration Date: | 10/09/2008 |
| NPI Last Update Date: | 10/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 4074924 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |