MEDICARE: DEEDRIA WALDROP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1427833003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEDRIA WALDROP

Provider Business Mailing Address
First Line	:	3621 MARION LN
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-7579
Country	:	US
Telephone Number	:	575-520-6074
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 JEFFERSON ST STE 118
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62301-5654
Country	:	US
Telephone Number	:	217-275-0370
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2023
Last Update Date	:	07/25/2025

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Directions to “ DEEDRIA WALDROP ” Practice Location

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