Healthcare Provider Details

I. General information

NPI: 1730859448
Provider Name (Legal Business Name): CARRIE DIEDE SPEECH LANGUAGE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 S MADISON ST
WALLA WALLA WA
99362-2416
US

IV. Provider business mailing address

62 S MADISON ST
WALLA WALLA WA
99362-2416
US

V. Phone/Fax

Practice location:
  • Phone: 646-331-6616
  • Fax: 509-260-2622
Mailing address:
  • Phone: 646-331-6166
  • Fax: 509-260-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARRIE S DIEDE
Title or Position: OWNER/THERAPIST
Credential: MS, CCC-SLP
Phone: 646-331-6616