Individual
DIETRA DUFFALA TEICHMANN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
5401 N KNOXVILLE AVE, SUITE 217, PEORIA, IL 61614-5098
(309) 282-1864
(309) 282-1867
Mailing address
5401 N KNOXVILLE AVE, SUITE 217, PEORIA, IL 61614-5098
(309) 282-1864
(309) 282-1867
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7272021
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
08/17/2005
Last updated
07/08/2007
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