Basic Information
| Provider Information | |||||||||
| NPI: | 1053907287 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIEL | ||||||||
| FirstName: | KRYSTAL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 126 6TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | RONAN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598642600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066763600 | ||||||||
| FaxNumber: | 4066763738 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 6TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | RONAN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598642600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066763600 | ||||||||
| FaxNumber: | 4066763738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2020 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 45162 | MT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.