Healthcare Provider Details

I. General information

NPI: 1477707354
Provider Name (Legal Business Name): JENNIFER G. DIER PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER G. DIER PLPC

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N MAIN ST
WINDSOR MO
65360-1449
US

IV. Provider business mailing address

307 N MAIN ST
WINDSOR MO
65360-1449
US

V. Phone/Fax

Practice location:
  • Phone: 660-647-2182
  • Fax: 660-647-2217
Mailing address:
  • Phone: 660-647-2182
  • Fax: 660-647-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2008032351
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: