Dieterich Comm Unit 30

Primary specialty

Local Education Agency (LEA)Taxonomy code 251300000X

Legal business name

DIETERICH COMM UNIT 30

Practice address

205 S. Pine
Dieterich, IL 62424

Phone

(217) 925-5249

Fax

(217) 925-5447

NPI assigned

Aug 25, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Bruce Owen

Title

Superintendent

Phone

(217) 925-5249

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598873176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 S. PINE",
            "address_2": "PO BOX 107",
            "city": "DIETERICH",
            "state": "IL",
            "postal_code": "62424",
            "telephone_number": "217-925-5249",
            "fax_number": "217-925-5447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 S. PINE",
            "city": "DIETERICH",
            "state": "IL",
            "postal_code": "62424",
            "telephone_number": "217-925-5249",
            "fax_number": "217-925-5447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIETERICH COMM UNIT 30",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OWEN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "SUPERINTENDENT",
        "authorized_official_telephone_number": "217-925-5249",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Rae Braddy, M.D.
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• Jennifer Tinsley Pmhnp-BC, PLLC (Life Story Behavioral Health)
• Kristen Rose Kennedy, M.S. CCC-SLP
• Jennifer Elizabeth Kistner, FNP

• Local Education Agency (LEA) in Dieterich, IL
• Providers in Dieterich, IL by specialty
• Local Education Agency (LEA) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.