Debra Dietrich, PSYCHOLOGIST

NPI #1396947974 in Bloomington, Illinois

Provider Information

NPI Number: 1396947974
Entity Type: Individual
Name: Debra Dietrich, PSYCHOLOGIST
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Psychologist - School
Credential: PSYCHOLOGIST
Enumeration Date: Jun 5, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 2404 E EMPIRE ST
City: Bloomington
State: Illinois
ZIP Code: 61704-3630
Phone: (309) 663-8275

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - School — School	103TS0200X	Primary

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