Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 102L00000X | Psychologist | R0218 | MO |
N | 103T00000X | Psychologist | R0218 | MO |
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103G00000X | Clinical Psychologist | R0218 | MO |
N | 103TC0700X | Clinical Psychologist | R0218 | MO |
N | 103TC1900X | Counseling Psychologist | ||
N | 103TC2200X | Clinical Child & Adolescent Psychologist | R0218 | MO |
N | 103TF0000X | Family Psychologist | ||
N | 103TM1800X | Intellectual & Developmental Disabilities |
NPI | 1235120650 |
---|---|
Provider Name | Dr. Cheryl L. Nietfeldt |
First Address | Kirkwood, MO 63122-6844 |
Second Address | Kirkwood, MO 63122-6844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
251558 | VALUE OPTIONS ID (01) | MO |
43098515915 | CMR (01) | MO |
433774 | HEALTHLINK (01) | MO |
487V3 | BLUE CROSS BLUE SHIELD (01) | MO |
6111080 | UNITED BEHAVIORAL HEALTH (01) | MO |