| Christina R. Diesen, Lcsw | |
|
110 N Main St Breese IL 62230-1630 | |
| (618) 322-6424 | |
| (618) 227-8227 |
| Full Name | Christina R. Diesen, Lcsw |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 110 N Main St, Breese, Illinois |
| Authorized Official Name and Position | Christina R Diesen (OWNER) |
| Authorized Official Contact | 6183226424 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Christina R. Diesen, Lcsw 110 N Main St Breese IL 62230-1630 Ph: (618) 322-6424 | Christina R. Diesen, Lcsw 110 N Main St Breese IL 62230-1630 Ph: (618) 322-6424 |
| NPI Number | 1841739620 |
|---|---|
| Provider Enumeration Date | 02/14/2017 |
| Last Update Date | 10/07/2020 |
| Certification Date | 10/07/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841739620 | NPI | - | NPPES |
| 1326161969 | Other | IL | NPI 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149-010456 (Illinois) | Primary |
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