Provider Demographics
NPI:1003460809
Name:CAUDILL, DIANA LYNN (HAS)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LYNN
Other - Last Name:MONNIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HAS
Mailing Address - Street 1:812 E NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-3016
Mailing Address - Country:US
Mailing Address - Phone:937-387-9700
Mailing Address - Fax:614-868-3233
Practice Address - Street 1:812 E NATIONAL RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-3016
Practice Address - Country:US
Practice Address - Phone:937-387-9700
Practice Address - Fax:614-868-3233
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2681237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist