Provider Demographics
NPI:1437402385
Name:DIERKER, CASSANDRA (MS)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:DIERKER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:DIERKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4604 JAYDEN CT
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-9148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4604 JAYDEN CT
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-9148
Practice Address - Country:US
Practice Address - Phone:417-464-9254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor