Shannon Marie Dietrich, BA
Individual provider Active NPI Counselor · Quincy, IL
NPI 1083708796 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1083708796
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 4409 Maine
Quincy, IL 62305-3646 - Phone
- (217) 223-0423
- Fax
- (217) 223-0461
- NPI assigned
- Oct 3, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Bachelor of Arts
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
4409 Maine
Quincy, IL 62305-3646
Mailing address
3107 Fox Run East
Quincy, IL 62301
Phone (217) 223-0413
Other providers in Quincy, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.