Individual
JACKIE DIETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
640 3RD ST, GAYLORD, MN 55334-2297
(507) 237-8730
Mailing address
640 3RD ST, GAYLORD, MN 55334-2297
(507) 237-8730
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8784
MN
Other
Enumeration date
11/21/2012
Last updated
11/21/2012
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