Provider Demographics
NPI:1033410584
Name:WHITEHURST, DIANE LORRAINE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LORRAINE
Last Name:WHITEHURST
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 DEYERLE AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8025
Mailing Address - Country:US
Mailing Address - Phone:540-574-2982
Mailing Address - Fax:
Practice Address - Street 1:2101 DEYERLE AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8025
Practice Address - Country:US
Practice Address - Phone:540-574-2982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist