Provider Demographics
NPI:1003169558
Name:ACEVEDO, DIANA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3887
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0409
Mailing Address - Country:US
Mailing Address - Phone:919-684-6271
Mailing Address - Fax:
Practice Address - Street 1:40 DUKE MEDICINE CIR # 1I
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-4000
Practice Address - Country:US
Practice Address - Phone:919-684-3451
Practice Address - Fax:919-684-6271
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006743235Z00000X
NC10568235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist