Provider Demographics
NPI:1033589007
Name:DIEHM, TRACY (BC-HIS)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:DIEHM
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-1949
Mailing Address - Country:US
Mailing Address - Phone:082-852-7726
Mailing Address - Fax:
Practice Address - Street 1:128 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-1949
Practice Address - Country:US
Practice Address - Phone:608-285-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV525237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVHAS-525OtherNEVADA SPEECH-LANGUAGE PATHOLOGY, AUDIOLOGY & HEARING AID DISPENSING BOARD