Active NPI
Marcia C Diederich
- School Psychologist
- Phoenix, AZ
National Provider Identifier
1003067919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 4074924
- Practice address
- 25250 N 35TH Ave
Phoenix, AZ 85083-4335 - Phone
- (623) 445-7100
- Fax
- (623) 445-7180
- NPI assigned
- Oct 9, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 4074924 | AZ | Primary |
Addresses
Primary practice location
25250 N 35TH Ave
Phoenix, AZ 85083-4335
Mailing address
25250 N 35TH Ave
Phoenix, AZ 85083-4335
Phone (623) 445-7100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4074924 | AZ | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223510400000",
"number": "1003067919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25250 N 35TH AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850834335",
"telephone_number": "623-445-7100",
"fax_number": "623-445-7180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25250 N 35TH AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850834335",
"telephone_number": "623-445-7100",
"fax_number": "623-445-7180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIEDERICH",
"first_name": "MARCIA",
"middle_name": "C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-09",
"last_updated": "2008-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "AZ",
"license": "4074924",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.