Individual
MS. JODY SUSANNE DIEBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
1008 N MAIN ST, SIKESTON, MO 63801-5044
(573) 472-7619
(573) 472-7149
Mailing address
1008 N MAIN ST, SIKESTON, MO 63801-5044
(573) 472-7619
(573) 472-7149
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2004003165
MO
Other
Enumeration date
02/20/2013
Last updated
02/28/2013
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