Stacy Diekmann, SSP, NCSP – School Psychologist

Key facts

NPI: 1235657941
Entity type: Individual (NPI type 1)
Primary specialty: School Psychologist 103TS0200X
License: 616587 (IL)
Practice address: 1525 Locust St
Red Bud, IL 62278-1374
Phone: (618) 282-6251
NPI assigned: Sep 1, 2017
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Perandoe Special Education District Local Education Agency (LEA) · Red Bud, IL · NPI 1871792648

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
1836187	IL	MD	School Psychologist
616587	IL	MD	School Psychologist

Practice roles

Organization	Specialty	Status	New patients
Perandoe Special Education District		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
School Psychologist	103TS0200X
School Psychologist	103TS0200X	1836187	IL
School Psychologist	103TS0200X	616587	IL	Yes

Addresses

Primary practice location

1525 Locust St
Red Bud, IL 62278-1374

Mailing address

1525 Locust St
Red Bud, IL 62278-1374

Other providers in Red Bud, IL

All providers in Red Bud, IL · School Psychologist in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2017. 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.

Verify at the official NPI Registry.