| Doctor Name: | MS. JACQUELINE KAY DIERCKS |
| NPI Number: | 1295960144 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 460776H |
| Business Practice Address: | 6511 Ne 18th St Vancouver, WA - 986616869 |
| Business Phone Number: | 3607594917 |
| Business Fax Number: | 3607594921 |
| Mailing Address: | Po Box 2277, VANCOUVER |
| State: | WA |
| Postal Code: | 986682277 |
| Phone Number: | 3607594917 |
| Fax Number: | 3607594921 |
| NPI Enumeration Date: | 05/21/2009 |
| NPI Last Update Date: | 05/21/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 460776H |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |