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General NPI Number Information
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NPI Number | 1033897772
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Entity Type | Organization
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Legal Business Name | SWEET SPRINGS CONSULTATION AND ASSESSMENT PLLC
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 720 PIKE STREET SUITE 3
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City | LEMONT
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State | PA
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Zip | 16851
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Country | US
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Telephone | 814-831-6171
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 741
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City | LEMONT
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State | PA
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Zip | 16851-0741
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | LEANN T DIEDERICH
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Credential | PHD
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Telephone | 814-831-6171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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