Individual
MS. TAMI LUELLA DIEDIKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PLMHP
Contact information
Practice address
200 N 34TH, NORFOLK, NE 68702
(402) 371-3044
(402) 371-9643
Mailing address
1002 2ND AVE, WAYNE, NE 68787
(402) 375-2932
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7803
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47083165926
—
NE
01
—
47083165927
MEDICAID
NE
Enumeration date
08/04/2006
Last updated
07/08/2007
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