Provider Demographics
NPI:1134553506
Name:DIECKHOFF, ERIN LEIGH (LCPC)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:LEIGH
Last Name:DIECKHOFF
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5203
Mailing Address - Country:US
Mailing Address - Phone:773-653-8694
Mailing Address - Fax:
Practice Address - Street 1:5825 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5203
Practice Address - Country:US
Practice Address - Phone:773-653-8694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008280101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional