Provider Demographics
NPI:1407384092
Name:DIEDE, ASHTON MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:MARIE
Last Name:DIEDE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MENNO
Mailing Address - State:SD
Mailing Address - Zip Code:57045-2170
Mailing Address - Country:US
Mailing Address - Phone:605-660-7817
Mailing Address - Fax:
Practice Address - Street 1:1200 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4358
Practice Address - Country:US
Practice Address - Phone:605-995-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD20000274032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer