Provider Demographics
NPI:1588897318
Name:DIETZ, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DIETZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 SW 101ST RD
Mailing Address - Street 2:
Mailing Address - City:CHILHOWEE
Mailing Address - State:MO
Mailing Address - Zip Code:64733-9139
Mailing Address - Country:US
Mailing Address - Phone:660-653-0086
Mailing Address - Fax:
Practice Address - Street 1:1095 SW 101ST RD
Practice Address - Street 2:
Practice Address - City:CHILHOWEE
Practice Address - State:MO
Practice Address - Zip Code:64733-9139
Practice Address - Country:US
Practice Address - Phone:660-653-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst