Provider Demographics
NPI:1639832959
Name:DIERICK, KRISTEN NICOLE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:NICOLE
Last Name:DIERICK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2716
Mailing Address - Country:US
Mailing Address - Phone:907-209-1657
Mailing Address - Fax:
Practice Address - Street 1:1401 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6371
Practice Address - Country:US
Practice Address - Phone:509-662-5504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist