Provider Demographics
NPI:1780741942
Name:DIERKING, DARCIA M (AUD)
Entity type:Individual
Prefix:DR
First Name:DARCIA
Middle Name:M
Last Name:DIERKING
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:DARCIA
Other - Middle Name:M
Other - Last Name:TIDEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-672-6000
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-672-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001331231H00000X
NE214231H00000X
MN9260231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE06633OtherBCBS BT
NE06634OtherBCBS ENT
IA1585323Medicaid
IA9585323Medicaid
IA7585323Medicaid
IA4585323Medicaid
IA0585323Medicaid
IA0585349Medicaid
IA1585349Medicaid
IA5585323Medicaid
IA2585349Medicaid
IA6585323Medicaid
IA3585323Medicaid
IA3585349Medicaid
IA8285323Medicaid
IA2585349Medicaid
IA0585349Medicaid