Provider Demographics
NPI:1104554146
Name:DIETZEL, AUTUMN (LLBSW, DP-C)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:DIETZEL
Suffix:
Gender:
Credentials:LLBSW, DP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 STATE RD
Mailing Address - Street 2:
Mailing Address - City:VASSAR
Mailing Address - State:MI
Mailing Address - Zip Code:48768-9249
Mailing Address - Country:US
Mailing Address - Phone:989-220-9525
Mailing Address - Fax:
Practice Address - Street 1:1009 WASHINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5705
Practice Address - Country:US
Practice Address - Phone:989-928-3566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker