Provider Demographics
NPI:1255563896
Name:FRIEDERICH, DIANE B (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:B
Last Name:FRIEDERICH
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:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92593-0538
Mailing Address - Country:US
Mailing Address - Phone:951-491-5566
Mailing Address - Fax:
Practice Address - Street 1:25405 HANCOCK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5982
Practice Address - Country:US
Practice Address - Phone:951-696-4308
Practice Address - Fax:951-696-4309
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-16
Last Update Date:2009-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9168235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist