Provider Demographics
NPI:1215068317
Name:DIETZEL, MICHAELE EILEEN
Entity type:Individual
Prefix:
First Name:MICHAELE
Middle Name:EILEEN
Last Name:DIETZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 W 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-1011
Mailing Address - Country:US
Mailing Address - Phone:509-624-8439
Mailing Address - Fax:
Practice Address - Street 1:707 W 7TH AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2832
Practice Address - Country:US
Practice Address - Phone:509-624-8418
Practice Address - Fax:509-624-5056
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010422101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health