Provider Demographics
NPI:1447798723
Name:DIEDE, CARRIE S (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:S
Last Name:DIEDE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:646-331-6616
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
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60647773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist