Provider Demographics
NPI:1730859448
Name:CARRIE DIEDE SPEECH LANGUAGE SERVICES
Entity type:Organization
Organization Name:CARRIE DIEDE SPEECH LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:DIEDE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:646-331-6616
Mailing Address - Street 1:62 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2416
Mailing Address - Country:US
Mailing Address - Phone:646-331-6166
Mailing Address - Fax:509-260-2622
Practice Address - Street 1:62 S MADISON ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2416
Practice Address - Country:US
Practice Address - Phone:646-331-6616
Practice Address - Fax:509-260-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Multi-Specialty