Provider Demographics
NPI:1598011470
Name:DIEL, PATRICIA R (LSW, CADC, SAP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:R
Last Name:DIEL
Suffix:
Gender:F
Credentials:LSW, CADC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 S. WILLOW
Mailing Address - Street 2:SUITE #7
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401
Mailing Address - Country:US
Mailing Address - Phone:217-347-7384
Mailing Address - Fax:217-347-0617
Practice Address - Street 1:444 S. WILLOW
Practice Address - Street 2:SUITE 7
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401
Practice Address - Country:US
Practice Address - Phone:217-347-7384
Practice Address - Fax:217-347-0617
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.007.438104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker