Provider Demographics
NPI:1982828463
Name:DIETCH, JUDITH K (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:K
Last Name:DIETCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 448
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-0448
Mailing Address - Country:US
Mailing Address - Phone:805-434-3586
Mailing Address - Fax:
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:STE D
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9366
Practice Address - Country:US
Practice Address - Phone:805-434-3586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY7294OtherPSYCHOLOGIST LIC