Provider Demographics
NPI:1174316400
Name:DIEDERICH, MICHELLE (PCC, BA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DIEDERICH
Suffix:
Gender:F
Credentials:PCC, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 58TH LN NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-9371
Mailing Address - Country:US
Mailing Address - Phone:408-940-5625
Mailing Address - Fax:
Practice Address - Street 1:5620 58TH LN NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-9371
Practice Address - Country:US
Practice Address - Phone:408-940-5625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach