Provider Demographics
NPI:1083164289
Name:BAGARELLA, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:BAGARELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 INDUSTRIAL DRIVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087
Mailing Address - Country:US
Mailing Address - Phone:603-870-0078
Mailing Address - Fax:603-870-8134
Practice Address - Street 1:3 INDUSTRIAL DRIVE
Practice Address - Street 2:UNIT 1
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087
Practice Address - Country:US
Practice Address - Phone:603-870-0078
Practice Address - Fax:603-870-8134
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1691235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist