Individual
TRACY DIERKSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, PLADC, RN
Contact information
Practice address
226 S GIBSON ST, HAY SPRINGS, NE 69347-4208
(308) 638-4411
(308) 638-4412
Mailing address
226 S GIBSON ST, PO BOX 86, HAY SPRINGS, NE 69347-4208
(308) 638-4411
(308) 638-4412
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
P-1077
NE
1041C0700X
Clinical Social Worker
Primary
1456, 4091
NE
163W00000X
Registered Nurse
53412
NE
Other
Enumeration date
03/04/2011
Last updated
10/28/2012
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