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General NPI Number Information
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NPI Number | 1104554146
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Entity Type | Individual
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Provider Name | AUTUMN DIETZEL LLBSW, DP-C
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Gender | Female
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 1009 WASHINGTON AVENUE
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City | BAY CITY
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State | MI
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Zip | 48708-5705
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Country | US
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Telephone | 989-928-3566
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Fax |
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Provider Business Mailing Address
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Address Line | 641 STATE RD
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City | VASSAR
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State | MI
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Zip | 48768-9249
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Country | US
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Telephone | 989-220-9525
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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