MEDICARE: MS. CHRISTINE ELIZABETH DIEHL LMSW

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
1	104100000X	Social Worker	10943	KS
2	104100000X	Social Worker	2018025718	MO

General Provider Information

NPI Number	:	1548899701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE ELIZABETH DIEHL LMSW

Provider Business Mailing Address
First Line	:	7124 BUENA VISTA ST
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-2830
Country	:	US
Telephone Number	:	913-558-2150
Fax Number	:

Provider Business Practice Location Address
First Line	:	13400 DONAHOO RD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-8400
Country	:	US
Telephone Number	:	913-558-2150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2020
Last Update Date	:	04/08/2020

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