Healthcare Provider Details

I. General information

NPI: 1932263175
Provider Name (Legal Business Name): TRICIA SIEFKER DYGERT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 NW HIGHWAY 131
ODESSA MO
64076-8111
US

IV. Provider business mailing address

938 NW HIGHWAY 131
ODESSA MO
64076-8111
US

V. Phone/Fax

Practice location:
  • Phone: 816-529-8465
  • Fax:
Mailing address:
  • Phone: 816-529-8465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005785
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: