Provider Demographics
NPI:1003067109
Name:DIANA G MASKER AND ASSOCIATES INC
Entity Type:Organization
Organization Name:DIANA G MASKER AND ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MASKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC
Authorized Official - Phone:321-751-1443
Mailing Address - Street 1:3040 N WICKHAM RD STE 4
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2369
Mailing Address - Country:US
Mailing Address - Phone:321-751-1443
Mailing Address - Fax:321-751-1448
Practice Address - Street 1:3040 N WICKHAM RD STE 4
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2369
Practice Address - Country:US
Practice Address - Phone:321-751-1443
Practice Address - Fax:321-751-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 3134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891929100Medicaid