Provider Demographics
NPI:1417188186
Name:DIETRICH-BURNS, KATIE ELLEN (MS)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:ELLEN
Last Name:DIETRICH-BURNS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6349 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1008
Mailing Address - Country:US
Mailing Address - Phone:410-718-8696
Mailing Address - Fax:410-477-3648
Practice Address - Street 1:6349 BEECHWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1008
Practice Address - Country:US
Practice Address - Phone:410-718-8696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03461235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist