Provider Demographics
NPI:1609657899
Name:DIEDERICH, ERIKA RENEE (LPC)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:RENEE
Last Name:DIEDERICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 GOLTL ST
Mailing Address - Street 2:
Mailing Address - City:LUDELL
Mailing Address - State:KS
Mailing Address - Zip Code:67744-4275
Mailing Address - Country:US
Mailing Address - Phone:620-282-1902
Mailing Address - Fax:
Practice Address - Street 1:485 W 4TH ST
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-2139
Practice Address - Country:US
Practice Address - Phone:785-460-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04523101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional