Provider Demographics
NPI:1528699071
Name:DIESI, SARAH MICHELLE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MICHELLE
Last Name:DIESI
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 1:124 MIRADA LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8060
Mailing Address - Country:US
Mailing Address - Phone:337-781-5074
Mailing Address - Fax:
Practice Address - Street 1:1700 KALISTE SALOOM RD STE 601
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6186
Practice Address - Country:US
Practice Address - Phone:337-306-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA127711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA84-3209407OtherN/A