Most Relevant Information
Provider Data
| NPI Number: | 1003067919 |
| Provider Name: | MARCIA C DIEDERICH |
| Entity Type: | Individual |
| Taxonomy Code: | 103TS0200X |
| Specialty: | Psychologist |
| License Number: | 4074924 |
Most Important Dates
| Enumeration Date: | 10/09/2008 |
| Last Updated: | 10/09/2008 |
Provider Practice Location
25250 N 35TH AVE
PHOENIX
AZ
850834335
Practice Location Phone/Fax
| Phone: | 6234457100 |
| Fax: | 6234457180 |
Provider Mailing Location
25250 N 35TH AVE
PHOENIX
AZ
850834335
Provider Mailing Phone/Fax
| Phone: | 6234457100 |
| Fax: | 6234457180 |