Individual
ROBERT J DIECKHOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
216 KEVIN CIR, MOUNT VERNON, MO 65712-9781
(417) 466-0530
(417) 667-2410
Mailing address
216 KEVIN CIR, MOUNT VERNON, MO 65712-9781
(417) 466-0530
(417) 667-2410
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
003822
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000078773
MEDICARE
MO
Enumeration date
04/04/2008
Last updated
04/04/2008
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