Provider Demographics
NPI:1568100915
Name:DIEBOLD, VALLE ANNE
Entity Type:Individual
Prefix:
First Name:VALLE
Middle Name:ANNE
Last Name:DIEBOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VALLE
Other - Middle Name:ANNE
Other - Last Name:GASTREICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 AUBURN TRACE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1702
Mailing Address - Country:US
Mailing Address - Phone:314-304-3536
Mailing Address - Fax:
Practice Address - Street 1:4625 LINDELL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3725
Practice Address - Country:US
Practice Address - Phone:636-387-9589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070125441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical