Healthcare Provider Details

I. General information

NPI: 1144180936
Provider Name (Legal Business Name): MICHELLE MARIE DIAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 10/14/2026
Certification Date: 10/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 S CLEARWATER LOOP STE B
POST FALLS ID
83854-5437
US

IV. Provider business mailing address

608 N 15TH ST
COEUR D ALENE ID
83814-5516
US

V. Phone/Fax

Practice location:
  • Phone: 208-777-2169
  • Fax:
Mailing address:
  • Phone: 208-651-2932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number8781406
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: