Provider Demographics
NPI:1356501563
Name:DIETZ, ERIN (LAC)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:DIETZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 S JUNETT ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6334
Mailing Address - Country:US
Mailing Address - Phone:206-351-5922
Mailing Address - Fax:
Practice Address - Street 1:4007 BRIDGEPORT WAY W STE C
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4330
Practice Address - Country:US
Practice Address - Phone:253-242-3661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 00003094171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist