Provider Demographics
NPI:1548710676
Name:NEAL, DIANNA (LCSW)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 STATE ROUTE VV
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-9108
Mailing Address - Country:US
Mailing Address - Phone:573-888-5925
Mailing Address - Fax:573-559-2409
Practice Address - Street 1:875 STATE ROUTE VV
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-9108
Practice Address - Country:US
Practice Address - Phone:573-888-5925
Practice Address - Fax:573-559-2409
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MO20200113951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker