MEDICARE: CARRIE S DIEDE M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	LL60647773	WA

General Provider Information

NPI Number	:	1447798723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE S DIEDE M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	62 S MADISON ST
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-2416
Country	:	US
Telephone Number	:	646-331-6616
Fax Number	:	509-260-2622

Provider Business Practice Location Address
First Line	:	62 S MADISON ST
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-2416
Country	:	US
Telephone Number	:	646-331-6616
Fax Number	:	509-260-2622

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2017
Last Update Date	:	09/14/2021

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Directions to “ CARRIE S DIEDE M.S., CCC-SLP” Practice Location

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