Individual
SALLIE DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
905 E 3RD ST, GROVE, OK 74344-7949
(918) 787-2104
(918) 787-2106
Mailing address
905 E 3RD ST, GROVE, OK 74344-7949
(918) 787-2104
(918) 787-2106
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
731013488
—
OK
Enumeration date
01/19/2010
Last updated
01/19/2010
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