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DIETRA DUFFALA TEICHMANN PH.D.

Clinical Neuropsychologist

Peoria, Illinois

Provider NPI: 1831181726

Provider Information:
 DIETRA DUFFALA TEICHMANN PH.D.
Gender: F


Practice Location:
5401 N KNOXVILLE AVE SUITE 217 PEORIA, IL 61614 US
Tel: 309-282-1864  Fax: 309-282-1867

Business Mailing Address:
5401 N KNOXVILLE AVE SUITE 217 PEORIA, IL 61614 US
Tel: 309-282-1864  Fax: 309-282-1867

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
IL

Other Provider Identifiers:

IssuerNumberStateType
BLUE CROSS/BLUE SHIELD7272021IL01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







CLINICAL NEUROPSYCHOLOGIST JOBS IL - Page 1

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