Provider Demographics
NPI:1164949772
Name:PASIECZNIK, DIANA LYNN (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:LYNN
Last Name:PASIECZNIK
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 ELMWOOD PARK DR APT 36
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7519
Mailing Address - Country:US
Mailing Address - Phone:718-541-2000
Mailing Address - Fax:
Practice Address - Street 1:85 ELMWOOD PARK DR APT 36
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7519
Practice Address - Country:US
Practice Address - Phone:718-541-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023322-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist