Richelle Lyn Dietz, MS, CCC-SLP

Individual provider Active NPI Speech-Language Pathologist · Casper, WY

NPI 1063256733 · NPPES record last updated Jun 19, 2024

Key facts

NPI
1063256733
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
SP-1328 (WY)
Practice address
2020 E 12TH St
Casper, WY 82601-4007
Phone
(307) 235-5097
NPI assigned
Jun 19, 2024
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
SP-1328WYMDSpeech-Language Pathologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP-1328 WY Yes

Addresses

Primary practice location

2020 E 12TH St
Casper, WY 82601-4007

Mailing address

2131 Mariposa Blvd
Casper, WY 82604-4823
Phone (307) 315-3895

Other providers in Casper, WY

All providers in Casper, WY · Speech-Language Pathologist in Wyoming

Sources for this page

Verify at the official NPI Registry.