Provider Demographics
NPI:1215181508
Name:LA SORSA, DIANA D (CCC-SL/P)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:D
Last Name:LA SORSA
Suffix:
Gender:F
Credentials:CCC-SL/P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 INCREASE MILLER RD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2711
Mailing Address - Country:US
Mailing Address - Phone:914-232-5517
Mailing Address - Fax:914-232-5616
Practice Address - Street 1:254 INCREASE MILLER RD
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-2711
Practice Address - Country:US
Practice Address - Phone:914-232-5517
Practice Address - Fax:914-232-5616
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004031-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist