Elisa Laura Diederich

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

1102 Issued in ND

Practice address

2400 47TH Ave S
Grand Forks, ND 58201-3405

Phone

(701) 746-2230

NPI assigned

Jan 19, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263859200000",
    "number": "1376874172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1173 LANDECO LN APT 201",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582018736",
            "telephone_number": "701-317-0331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 47TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582013405",
            "telephone_number": "701-746-2230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIEDERICH",
        "first_name": "ELISA",
        "middle_name": "LAURA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-01-19",
        "last_updated": "2010-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ND",
            "license": "1102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54002",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Dewitz
• Elise Dick, MD
• Mark Steven Dick, PHARMD
• Kara Dickinson, PMHNP-BC
• Gerard Dickmu, PMHNP
• Ann K Diepolder-Brown, MD
• Ronda Dietzler
• Jenna Difrischia, LAPC
• Sierra Rose Dirden, ATC
• McKenzie Ann Disrud, FNP

• Speech-Language Pathologist in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Speech-Language Pathologist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.