| Doctor Name: | MS. STACY R DIERKS |
| NPI Number: | 1104185107 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BA, CADC |
| License Number: | |
| Business Practice Address: | 50 Northgate Industrial Dr Granite City, IL - 620406805 |
| Business Phone Number: | 6188774420 |
| Business Fax Number: | |
| Mailing Address: | 50 Northgate Industrial Dr, GRANITE CITY |
| State: | IL |
| Postal Code: | 620406805 |
| Phone Number: | 6188774420 |
| Fax Number: | |
| NPI Enumeration Date: | 05/10/2012 |
| NPI Last Update Date: | 05/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |