Healthcare Provider Details

I. General information

NPI: 1013862895
Provider Name (Legal Business Name): LOREL GRACE DIERKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 OAK PARK VILLAGE DR
GROVER MO
63040-1418
US

IV. Provider business mailing address

353 OAK PARK VILLAGE DR
GROVER MO
63040-1418
US

V. Phone/Fax

Practice location:
  • Phone: 636-730-8426
  • Fax:
Mailing address:
  • Phone: 636-730-8426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: