Individual
SHANNON MARIE DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
4409 MAINE, QUINCY, IL 62305-3646
(217) 223-0423
(217) 223-0461
Mailing address
3107 FOX RUN EAST, QUINCY, IL 62301
(217) 223-0413
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/03/2006
Last updated
07/08/2007
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