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Organization

DIETRICH SPEECH & LANGUAGE SERVICES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. KRISTEN L. DIETRICH MS, CCC-SLP (OWNER, SPEECH-LANGUAGE PATHOLOGIST)
(843) 810-9198
Entity
Organization

Contact information

Practice address
3579 FRANKLIN TOWER DR, MOUNT PLEASANT, SC 29466-9383
(843) 810-9198
(855) 279-3149
Mailing address
3579 FRANKLIN TOWER DR, MOUNT PLEASANT, SC 29466-9383
(843) 810-9198
(855) 279-3149

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
235Z00000X
Speech-Language Pathologist
Primary
252Y00000X
Early Intervention Provider Agency
4516
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
30099867
MEDICAID - SELECT HEALTH
SC
05
GP5764
SC
05
SA1113
SC
Enumeration date
09/05/2011
Last updated
03/22/2021
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