Provider Demographics
NPI:1922203538
Name:DIAMOND R-IV SCHOOL
Entity Type:Organization
Organization Name:DIAMOND R-IV SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPED SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JINKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-325-7321
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:401 SOUTH MAIN ST.
Mailing Address - City:DIAMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64840-0068
Mailing Address - Country:US
Mailing Address - Phone:417-325-7321
Mailing Address - Fax:
Practice Address - Street 1:401 S. MAIN
Practice Address - Street 2:
Practice Address - City:DIAMOND
Practice Address - State:MO
Practice Address - Zip Code:64840
Practice Address - Country:US
Practice Address - Phone:417-325-7321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111952225100000X
MO004124225X00000X
MO116213235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty