Individual
STACY DIEKMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SSP, NCSP
Contact information
Practice address
1525 LOCUST ST, RED BUD, IL 62278-1374
(618) 282-6251
Mailing address
1525 LOCUST ST, RED BUD, IL 62278-1374
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
1836187
IL
103TS0200X
School Psychologist
Primary
616587
IL
103TS0200X
School Psychologist
—
—
Other
Enumeration date
09/01/2017
Last updated
09/01/2017
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