Provider Demographics
NPI:1235120650
Name:NIETFELDT, CHERYL L (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:L
Last Name:NIETFELDT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12166 OLD BIG BEND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6844
Mailing Address - Country:US
Mailing Address - Phone:314-909-0211
Mailing Address - Fax:314-909-0323
Practice Address - Street 1:12166 OLD BIG BEND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6844
Practice Address - Country:US
Practice Address - Phone:314-909-0211
Practice Address - Fax:314-909-0323
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0218103T00000X, 103TC0700X, 103TC2200X
103TB0200X, 103TF0000X, 103T00000X, 103TM1800X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO487V3OtherBLUE CROSS BLUE SHIELD
MO251558OtherVALUE OPTIONS ID
MO43098515915OtherCMR
MO433774OtherHEALTHLINK
MO6111080OtherUNITED BEHAVIORAL HEALTH