Provider Demographics
NPI:1356184857
Name:DIETRICH, MARIA (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 E SWAN CIR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1151
Mailing Address - Country:US
Mailing Address - Phone:636-541-2274
Mailing Address - Fax:
Practice Address - Street 1:3420 HARRY S TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4046
Practice Address - Country:US
Practice Address - Phone:636-926-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024020949235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist