MEDICARE: CARRIE DIEDE SPEECH LANGUAGE SERVICES

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	261QH0700X	Hearing and Speech Clinic/Center
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1730859448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARRIE DIEDE SPEECH LANGUAGE SERVICES

Provider Business Mailing Address
First Line	:	62 S MADISON ST
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-2416
Country	:	US
Telephone Number	:	646-331-6166
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	:	OWNER/THERAPIST
Name	:	CARRIE S DIEDE
Credential	:	MS, CCC-SLP
Telephone Number	:	646-331-6616

Provider Enumeration Date	:	09/14/2021
Last Update Date	:	10/18/2021

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Directions to “CARRIE DIEDE SPEECH LANGUAGE SERVICES ” Practice Location

Language	Start Address	Practice Location

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