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NPI Code Detail

MEDICARE: JESSICA DIEKE ED.S, NCSP, LPA

MEDICARE: JESSICA DIEKE ED.S, NCSP, LPA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist41042TX
2103TS0200XSchool Psychologist34309TX

General Provider Information

NPI Number : 1376475343
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA DIEKE ED.S, NCSP, LPA
Provider Business Mailing Address
First Line : 1255 W 15TH ST STE 320
Second Line :
City : PLANO
State : TX
Zip : 75075-7275
Country : US
Telephone Number : 817-371-0008
Fax Number :
Provider Business Practice Location Address
First Line : 1255 W 15TH ST STE 320
Second Line :
City : PLANO
State : TX
Zip : 75075-7275
Country : US
Telephone Number : 817-371-0008
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/02/2026

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