Individual
MS. JACQUELINE KAY DIERCKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6511 NE 18TH ST, VANCOUVER, WA 98661-6869
(360) 759-4917
(360) 759-4921
Mailing address
PO BOX 2277, VANCOUVER, WA 98668-2277
(360) 759-4917
(360) 759-4921
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
460776H
WA
Other
Enumeration date
05/21/2009
Last updated
05/21/2009
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