Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 2243 | KS |
NPI | 1003020827 |
---|---|
Provider Name | Lanis Dieker |
First Address | Emporia, KS 66801-3464 |
Second Address | Emporia, KS 66801-5367 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |