| NPI | 1144771403 |
|---|---|
| Former Name | AUDRA DIECKMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 1196-124) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 537-228) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2018-08-01 |