Provider Demographics
NPI:1205864758
Name:ROEDER, DIANE (MA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:ROEDER
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 1:3800 WOODWARD AVE
Mailing Address - Street 2:SUITE 702
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2061
Mailing Address - Country:US
Mailing Address - Phone:313-262-1303
Mailing Address - Fax:313-262-1238
Practice Address - Street 1:43494 WOODWARD
Practice Address - Street 2:STE 210
Practice Address - City:BLOOMFIELD TWP
Practice Address - State:MI
Practice Address - Zip Code:48302
Practice Address - Country:US
Practice Address - Phone:248-335-9800
Practice Address - Fax:248-253-9157
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist