Active NPI
Jacqueline Kay Diercks
- Speech-Language Pathologist
- Vancouver, WA
National Provider Identifier
1295960144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 460776H
- Practice address
- 6511 NE 18TH St
Vancouver, WA 98661-6869 - Phone
- (360) 759-4917
- Fax
- (360) 759-4921
- NPI assigned
- May 21, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 460776H | WA | Primary |
Addresses
Primary practice location
6511 NE 18TH St
Vancouver, WA 98661-6869
Mailing address
PO Box 2277
Vancouver, WA 98668-2277
Phone (360) 759-4917
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 460776H | WA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arc of Clark County | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Developmentally Disabled Services Day Training Agency
- Vancouver, WA
- NPI 1376872929
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242864000000",
"number": "1295960144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2277",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986682277",
"telephone_number": "360-759-4917",
"fax_number": "360-759-4921"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6511 NE 18TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986616869",
"telephone_number": "360-759-4917",
"fax_number": "360-759-4921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIERCKS",
"first_name": "JACQUELINE",
"middle_name": "KAY",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-21",
"last_updated": "2009-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WA",
"license": "460776H",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.