MEDICARE: ERIN E DIERICKX

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	106H00000X	Marriage & Family Therapist	MG61143094	WA
2	106H00000X	Marriage & Family Therapist	MFTA.MG.61143094	WA
3	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1790347466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN E DIERICKX

Provider Business Mailing Address
First Line	:	PO BOX 412
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-0412
Country	:	US
Telephone Number	:	206-313-3759
Fax Number	:

Provider Business Practice Location Address
First Line	:	6455 S 118TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98178-2936
Country	:	US
Telephone Number	:	206-313-3759
Fax Number	:

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

Provider Enumeration Date	:	07/02/2019
Last Update Date	:	05/26/2021

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Directions to “ ERIN E DIERICKX ” Practice Location

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