Provider Demographics
NPI:1033501986
Name:DIESTELKAMP, ROCHELLE DENISE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:DENISE
Last Name:DIESTELKAMP
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WALDEN CREEK TRCE
Mailing Address - Street 2:STE 22-3I
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-6502
Mailing Address - Country:US
Mailing Address - Phone:402-450-2562
Mailing Address - Fax:
Practice Address - Street 1:1511 NASHVILLE HWY
Practice Address - Street 2:STE A
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-2070
Practice Address - Country:US
Practice Address - Phone:931-490-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5514235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist