Provider Demographics
NPI:1093101800
Name:GALLEY, DIANA (SLPA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:GALLEY
Suffix:
Gender:F
Credentials:SLPA
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 770043
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-0043
Mailing Address - Country:US
Mailing Address - Phone:907-250-9061
Mailing Address - Fax:
Practice Address - Street 1:12350 INDUSTRY WAY STE 202
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-4301
Practice Address - Country:US
Practice Address - Phone:907-250-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK82355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant