Provider Demographics
NPI:1275974313
Name:HUENNEKE, DEIRDRE LEANNE (LMT)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:LEANNE
Last Name:HUENNEKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 COUNTY ROAD 222
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-3067
Mailing Address - Country:US
Mailing Address - Phone:314-440-8184
Mailing Address - Fax:
Practice Address - Street 1:3425 COUNTY ROAD 222
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-3067
Practice Address - Country:US
Practice Address - Phone:314-440-8184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010004095225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist