| Provider / Organization | NPI | Date Certified |
|---|---|---|
| KELSEY JEANETTE DIEDERICH | 1043862295 | 2022-12-04 |
Kelsey Jeanette Diederich is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1043862295. Registration indicates Kelsey Jeanette Diederich is a provider of access to mental health/behavioral health providers services with a specialization in Behavioral Health & Social Service Providers, Counselor (Behavioral Health & Social Service Providers, Counselor) (Counselor: Mental Health, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Counselor Mental Health, Behavioral Health & Social Service Providers) (Counselor, )
| Entity Type | Individual |
| Provider Name | Kelsey Jeanette Diederich LSW |
| Practice Office Address | 304 N LOOMIS ST CHICAGO, IL US |
| Practice Office Telephone | 3122438487 |
| Mailing Address | 304 N LOOMIS ST CHICAGO, IL 606071147 US |
| Business Telephone | 3122438487 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 1414 Main St | Melrose Park, IL 601603902 | 7086810073 |
| Code | Practice | License No State |
|---|---|---|
| 101YM0800X PRIMARY | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Counselor Behavioral Health & Social Service Providers Counselor Counselor: Mental Health Behavioral Health/Substance Abuse/Psychiatry Counselor Mental Health Behavioral Health & Social Service Providers Counselor | |
| 193200000X MULT | Group Code |