Individual
MS. JENNIFER ANN DIEBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
1390 US HIGHWAY 61, SUITE 3100, FESTUS, MO 63028-4137
(636) 931-7380
(636) 937-5546
Mailing address
1777 RICHARDSON RD, APT. 111, ARNOLD, MO 63010-6018
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
116740
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316065972
GROUP NPI
MO
Enumeration date
07/11/2006
Last updated
01/16/2009
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