Active NPI
Jackie Dietz
- Speech-Language Pathologist
- Gaylord, MN
National Provider Identifier
1881938397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 8784
- Practice address
- 640 3Rd St
Gaylord, MN 55334-2297 - Phone
- (507) 237-8730
- NPI assigned
- Nov 21, 2012
- 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 | 8784 | MN | Primary |
Addresses
Primary practice location
640 3Rd St
Gaylord, MN 55334-2297
Mailing address
640 3Rd St
Gaylord, MN 55334-2297
Phone (507) 237-8730
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 |
|---|---|---|---|
| 8784 | MN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353456000000",
"number": "1881938397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "640 3RD ST",
"city": "GAYLORD",
"state": "MN",
"postal_code": "553342297",
"telephone_number": "507-237-8730"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "640 3RD ST",
"city": "GAYLORD",
"state": "MN",
"postal_code": "553342297",
"telephone_number": "507-237-8730"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETZ",
"first_name": "JACKIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-11-21",
"last_updated": "2012-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "8784",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gaylord, MN
- Colleen Kay Bulau - Overson, LICSW
- Teresa Ann Burmis
- City of Gaylord (Gaylord Ambulance Service)
- County of Sibley (Sibley County Public Health and Human Services)
- County of Sibley (Sibley County Human Services)
- Ashley Maria Engles, M.S. CF-SLP
- First Choice Pharmacy Inc (First Choice Pharmacy)
- First Choice Pharmacy of Gaylord MN, PLLC
- Emma Jo Fowler, D.C.
- Josh Daniel Gavin, PTA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.