Provider Demographics
NPI:1033897772
Name:SWEET SPRINGS CONSULTATION AND ASSESSMENT PLLC
Entity Type:Organization
Organization Name:SWEET SPRINGS CONSULTATION AND ASSESSMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:T
Authorized Official - Last Name:DIEDERICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:814-831-6171
Mailing Address - Street 1:PO BOX 741
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:16851-0741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 PIKE STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:LEMONT
Practice Address - State:PA
Practice Address - Zip Code:16851
Practice Address - Country:US
Practice Address - Phone:814-831-6171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center