Healthcare Provider Details

I. General information

NPI: 1780523233
Provider Name (Legal Business Name): DEIDRE LEANN PICKETT MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 HIGHLAND DRIVE
HAYFORK CA
96041
US

IV. Provider business mailing address

PO BOX 901
HAYFORK CA
96041-0901
US

V. Phone/Fax

Practice location:
  • Phone: 530-227-4031
  • Fax:
Mailing address:
  • Phone: 530-227-4031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP14440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: