Dietrich, Sallie

Dietrich, Sallie is an individual health care provider with primary practice located at 905 E 3Rd St , Grove OK 74344-7949. She recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as her primary health care specialty. Dietrich, Sallie can be contacted via phone (918) 787-2104.

Contact Information

Primary practice address
905 E 3Rd St Grove OK 74344-7949
Phone: (918) 787-2104
Fax: (918) 787-2106
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X

Profile Details

NPI number 1992036693
LBN Legal business name Dietrich, Sallie
Credentials MS
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 19th, 2010
Last updated Jan 19th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992036693 NPPES
Oklahoma MEDICAID 731013488

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