Provider Demographics
NPI:1679158265
Name:DIETRICH, PATTI SANDERS (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:SANDERS
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5836 WESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-2861
Mailing Address - Country:US
Mailing Address - Phone:225-505-8822
Mailing Address - Fax:
Practice Address - Street 1:5836 WESTRIDGE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-2861
Practice Address - Country:US
Practice Address - Phone:225-505-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2403235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist