Provider Demographics
NPI:1124215116
Name:NENS, DIANE DOVE (MA, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:DOVE
Last Name:NENS
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:LOUISE
Other - Last Name:DOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:734-525-3900
Mailing Address - Fax:734-525-4020
Practice Address - Street 1:14700 FARMINGTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5430
Practice Address - Country:US
Practice Address - Phone:734-525-3900
Practice Address - Fax:734-525-4020
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000360231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1124215116Medicaid
MI1124215116Medicaid