Provider Demographics
NPI:1174884100
Name:DIETRICH, ADRIENNE KELLY (MS, ED)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:KELLY
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7289 RICE RD
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-9600
Mailing Address - Country:US
Mailing Address - Phone:315-376-4208
Mailing Address - Fax:
Practice Address - Street 1:18564 US ROUTE 11
Practice Address - Street 2:SUITE 5
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5900
Practice Address - Country:US
Practice Address - Phone:315-786-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist