Provider Demographics
NPI:1629819230
Name:DIETRICH, VIRGINIA FAITH (MA CF-SLP)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:FAITH
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 LAKE BEAU PRE BLVD APT 65
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70820-4267
Mailing Address - Country:US
Mailing Address - Phone:225-505-8822
Mailing Address - Fax:
Practice Address - Street 1:3455 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1640
Practice Address - Country:US
Practice Address - Phone:225-244-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist