MEDICARE: MICHELLE DIEDERICH B.S.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	171400000X	Health & Wellness Coach	WA
2	174H00000X	Health Educator	WA
3	101YM0800X	Mental Health Counselor	WA

General Provider Information

NPI Number	:	1174316400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE DIEDERICH B.S.

Provider Business Mailing Address
First Line	:	5620 58TH LN NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-9371
Country	:	US
Telephone Number	:	408-940-5625
Fax Number	:

Provider Business Practice Location Address
First Line	:	5620 58TH LN NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-9371
Country	:	US
Telephone Number	:	408-940-5625
Fax Number	:

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

Provider Enumeration Date	:	05/28/2025
Last Update Date	:	03/16/2026

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Directions to “ MICHELLE DIEDERICH B.S.” Practice Location

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