Provider Demographics
NPI:1174828917
Name:RUDD, DIANNA SPRAY (MA)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:SPRAY
Last Name:RUDD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-4440
Mailing Address - Country:US
Mailing Address - Phone:765-860-4043
Mailing Address - Fax:
Practice Address - Street 1:522 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4440
Practice Address - Country:US
Practice Address - Phone:765-860-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health