Provider Demographics
NPI:1194826321
Name:BURKE, DIANE R (MS)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:R
Last Name:BURKE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1441 CHERRY LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-6811
Mailing Address - Country:US
Mailing Address - Phone:405-364-6579
Mailing Address - Fax:405-364-0159
Practice Address - Street 1:1412 N PORTER AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6662
Practice Address - Country:US
Practice Address - Phone:405-321-8882
Practice Address - Fax:405-364-0152
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK248235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100655220AMedicaid