Individual provider · Type 1 NPI

Wanda Diderich

Professional Counselor · Rockford, IL

NPI number 1396259081 Active

Practice location

8616 Northern Ave
Rockford, IL 61107-5309

Call (815) 332-8003 Map

Fax (815) 332-6090

Mailing address

1021 N Mulford Rd
Rockford, IL 61107-3877

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor Primary 101YP2500X178013374 (IL)

Professional Counselor: Definition to come...

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About NPI 1396259081

Wanda Diderich's National Provider Identifier is 1396259081, issued on Nov 17, 2017. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Rockford, IL. The record was last updated on Nov 17, 2017.