Active NPI
Kristen Lankford Dietrich, MS, CCC-SLP
- Speech-Language Pathologist
- Mount Pleasant, SC
National Provider Identifier
1295966794
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 4516
- Practice address
- 3579 Franklin Tower Dr
Mount Pleasant, SC 29466-9383 - Phone
- (843) 810-9198
- Fax
- (855) 279-3149
- NPI assigned
- Jul 31, 2009
- Sex
- Female
- Sole proprietor
- Yes
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 | 4516 | SC | Primary |
Addresses
Primary practice location
3579 Franklin Tower Dr
Mount Pleasant, SC 29466-9383
Mailing address
3579 Franklin Tower Dr
Mount Pleasant, SC 29466-9383
Phone (843) 810-9198
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SA1113 | Medicaid | SC | |
| 30099867 | Other | SC | MEDICAID - SELECT HEALTH |
| GP5764 | Medicaid | SC |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4516 | SC | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dietrich Speech & Language Services, LLC | Speech-Language Pathologist | Current | 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.
-
- Speech-Language Pathologist
- Mount Pleasant, SC
- NPI 1760763718
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680048000000",
"number": "1295966794",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3579 FRANKLIN TOWER DR",
"city": "MOUNT PLEASANT",
"state": "SC",
"postal_code": "294669383",
"telephone_number": "843-810-9198",
"fax_number": "855-279-3149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3579 FRANKLIN TOWER DR",
"city": "MOUNT PLEASANT",
"state": "SC",
"postal_code": "294669383",
"telephone_number": "843-810-9198",
"fax_number": "855-279-3149"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETRICH",
"first_name": "KRISTEN",
"middle_name": "LANKFORD",
"credential": "MS, CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-07-31",
"last_updated": "2023-03-29",
"certification_date": "2023-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "SC",
"license": "4516",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SA1113",
"state": "SC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID - SELECT HEALTH",
"identifier": "30099867",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GP5764",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Pleasant, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.