Provider Demographics
NPI:1710327648
Name:DIEDRICH, CAITLIN
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:
Last Name:DIEDRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:MOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:969 S FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-4946
Mailing Address - Country:US
Mailing Address - Phone:630-217-9675
Mailing Address - Fax:
Practice Address - Street 1:270 S HAGANS AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3117
Practice Address - Country:US
Practice Address - Phone:630-217-9675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.011624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist