Provider Demographics
NPI:1144669946
Name:BIDAWID UCHIYAMA, DIANA MARIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MARIA
Last Name:BIDAWID UCHIYAMA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:MARIA
Other - Last Name:BIDAWID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JD
Mailing Address - Street 1:1542 WADSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-7442
Mailing Address - Country:US
Mailing Address - Phone:630-642-9089
Mailing Address - Fax:630-690-5663
Practice Address - Street 1:328 S 3RD ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2772
Practice Address - Country:US
Practice Address - Phone:630-642-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008526103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical