Individual
CRYSTAL LIEDTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3403 HEARTLAND ST, MARION, IL 62959-6393
(618) 997-5311
Mailing address
3403 HEARTLAND ST, MARION, IL 62959-6393
(618) 997-5311
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149020496
IL
Other
Enumeration date
10/03/2018
Last updated
10/03/2018
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