Provider Demographics
NPI:1528035672
Name:DIEDE, DOROTHY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:
Last Name:DIEDE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:
Other - Last Name:DIEDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:46314 TIMINE WAY
Mailing Address - Street 2:PO BOX 160
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0160
Mailing Address - Country:US
Mailing Address - Phone:509-682-8517
Mailing Address - Fax:509-682-6131
Practice Address - Street 1:46314 TIMINE WAY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-0160
Practice Address - Country:US
Practice Address - Phone:541-966-9830
Practice Address - Fax:541-278-7568
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00006833104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1080282Medicaid
WAP74435Medicare UPIN