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 1:4815 W RUSSELL RD
Mailing Address - Street 2:6F
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-6241
Mailing Address - Country:US
Mailing Address - Phone:702-608-4327
Mailing Address - Fax:702-222-0705
Practice Address - Street 1:4815 W RUSSELL RD
Practice Address - Street 2:6F
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-6241
Practice Address - Country:US
Practice Address - Phone:702-608-4327
Practice Address - Fax:702-222-0705
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
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