DIETRA DUFFALA TEICHMANN (NPI# 1831181726) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1831181726 |
Entity Type | Individual |
Full Name | DIETRA DUFFALA TEICHMANN |
Credential | PH.D. |
Practice Address |
5401 N Knoxville Ave Suite 217 Peoria IL 61614-5098 |
Practice Telephone | 3092821864 |
Practice Fax Number | 3092821867 |
Mailing Telephone | 3092821864 |
Mailing Fax Number | 3092821867 |
Enumeration Date | 2005-08-17 |
Last Update Date | 2007-07-08 |
Gender Code | F |
Is Sole Proprietor | X |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 103G00000X | Clinical Neuropsychologist | IL | Behavioral Health & Social Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IL | BLUE CROSS/BLUE SHIELD | 7272021 | 01 |
Street Address |
5401 N KNOXVILLE AVE SUITE 217 |
City | PEORIA |
State | IL |
Zip Code | 61614-5098 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1871597450 | Edward A Rufus Jr | Internal Medicine | 5401 N Knoxville Ave, Suite 306, Peoria, IL 61614-5098 | 2005-06-10 |
1366984015 | Taylor Jeanette Simmons | Specialist/Technologist | 5401 N Knoxville Ave, Suite 103, Peoria, IL 61614-5098 | 2016-11-11 |
1518416254 | Illinois Regional Pain Institute | Nurse Practitioner | 5401 N Knoxville Ave, Suite 416, Peoria, IL 61614-5098 | 2016-09-22 |
1700331030 | Deb M Schleich | Nurse Practitioner | 5401 N Knoxville Ave, Suite 416, Peoria, IL 61614-5098 | 2016-08-16 |
1154876498 | Kimberly K Lopez | Nurse Practitioner | 5401 N Knoxville Ave, Suite 416, Peoria, IL 61614-5098 | 2016-08-16 |
1417320854 | Amy B Pheiffer | Clinical Nurse Specialist | 5401 N Knoxville Ave, Suite 109, Peoria, IL 61614-5098 | 2015-11-06 |
1558732370 | Leah Tabor | Specialist/Technologist, Other | 5401 N Knoxville Ave, Suite 117, Peoria, IL 61614 | 2015-10-20 |
1679944334 | Midwest Pain & Spine Center, LLC | Specialist | 5401 N Knoxville Ave, Suite 416, Peoria, IL 61614-5098 | 2015-10-07 |
1124495379 | Anne Webster | Nurse Practitioner | 5401 N Knoxville Ave, Suite 416, Peoria, IL 61614-5098 | 2015-08-24 |
1720461353 | Hometown Hearing & Audiology, Inc. | Audiologist | 5401 N Knoxville Ave, 116, Peoria, IL 61614-5011 | 2015-07-01 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1548818511 | Christine Svoboda | Social Worker | 6919 N Knoxville Ave Ste 100 and 202, Peoria, IL 61614 | 2019-09-03 |
1639649007 | Kathy Karouzos Counseling, LLC | Clinic/Center | 330 W. Ivy Ln., Peoria, IL 61614 | 2018-11-28 |
1205312790 | Kathleen Marie Hendricks | Nurse Practitioner | 2809 W Willow Knolls Dr, Peoria, IL 61614 | 2018-07-17 |
1629563937 | Mary Elizabeth Cunningham | Counselor | 6219 N. Eldorado Dr., Peoria, IL 61614 | 2018-06-28 |
1861937955 | Angela Gilles | Social Worker | 6919 N Knoxville Ave Ste 100, Peoria, IL 61614 | 2016-12-27 |
1467994897 | Melissa Saxsma | Specialist | 5009 N Executive Dr, Peoria, IL 61614 | 2016-11-16 |
1902258874 | Rashid Plastic Surgery, LLC | Plastic Surgery | 804 W Trailcreek Drive, Peoria, IL 61614 | 2016-07-05 |
1215313143 | Melissa Lynn Phelan | Nurse Practitioner | 122 E Morningside Dr, Peoria, IL 61614 | 2015-08-03 |
1811380165 | All Ways Caring Services, Inc. | In Home Supportive Care | 6919 N Knoxville Ave, Suite 102, Peoria, IL 61614 | 2015-03-11 |
1568875920 | Schuler & Arkwell Orthodontic Partnership | Dentist | 2425 Cornerstone Ct. Ste. A, Peoria, IL 61614 | 2014-06-03 |
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Taxonomy Code | 103G00000X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Clinical Neuropsychologist |
An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1174927172 | Christopher Simpson | Clinical Neuropsychologist | 10184 W Happy Valley Rd, Suite 190, Peoria, AZ 85383-1254 | 2014-10-20 |
1891800603 | Shanna Marie Kurth | Clinical Neuropsychologist | 3100 N Dries Ln, Ste 303, Peoria, IL 61604-1265 | 2006-08-20 |
1003425786 | Brycie Weiden | Clinical Neuropsychologist | 515 Ne Glen Oak Ave Ste 101, Peoria, IL 61603-3167 | 2020-07-28 |
1649723990 | Eric Aune | Clinical Neuropsychologist | 530 Ne Glen Oak Ave, Children's Hospital of Illinois, Peoria, IL 61637-0001 | 2016-08-03 |
1053658377 | Benjamin Joseph Richter | Clinical Neuropsychologist | 515 Ne Glen Oak Ave, Suite 101, Peoria, IL 61637-3167 | 2013-01-07 |
1740459429 | Amy Serin | Clinical Neuropsychologist | 10200 W Happy Valley Rd, Suite A135, Peoria, AZ 85383-2878 | 2008-02-26 |
1659553444 | Neuropsychology Clinic PC | Clinical Neuropsychologist | 3100 N Dries Ln, Ste 303, Peoria, IL 61604-1265 | 2007-12-04 |
1659396505 | Michele R. Verda | Clinical Neuropsychologist | 420 Ne Glen Oak Ave, 401, Peoria, IL 61603-3105 | 2006-07-13 |
1962456764 | Saint Francis Medical Center | Clinical Neuropsychologist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2006-05-19 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1477183556 | Michelle Yvonne Kibby-faglier | Clinical Neuropsychologist | 285 Lake Indian Hills Dr, Carbondale, IL 62902-6184 | 2020-01-17 |
1003456708 | David Jackson | Clinical Neuropsychologist | 6 Parkway North Blvd, Deerfield, IL 60015-2522 | 2020-01-10 |
1649830159 | Natalie Berger | Clinical Neuropsychologist | 1645 W Jackson Blvd Ste 203, Chicago, IL 60612-3227 | 2019-06-17 |
1043877475 | Sarah Mailander Dyer | Clinical Neuropsychologist | 900 Royal Heights Rd Ste 14, Belleville, IL 62226-5457 | 2019-05-21 |
1639655632 | Julia Digangi | Clinical Neuropsychologist | 920 N York Rd, Hinsdale, IL 60521-2996 | 2018-07-13 |
1891211710 | Kenneth Vicencio | Clinical Neuropsychologist | 4100 Healthway Drive, Aurora, IL 60504 | 2017-08-22 |
1538690466 | Kathleen Ares | Clinical Neuropsychologist | 4440 W 95th, Suite 1200h, Oak Lawn, IL 60453 | 2017-03-22 |
1225575871 | Israel Gross | Clinical Neuropsychologist | 1934 W. Roscoe St., #4, Chicago, IL 60657 | 2017-01-20 |
1013462829 | Ann Westcot Jordan | Clinical Neuropsychologist | 21037 Benjamin Dr, Shorewood, IL 60404-0612 | 2016-08-22 |
1740638915 | Elizabeth Regina Tuminello Hartman | Clinical Neuropsychologist | 1875 Dempster St Ste 520, Park Ridge, IL 60068-1130 | 2016-05-29 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.