Provider Demographics
NPI:1215375118
Name:ROOT, DIANA GAY (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:GAY
Last Name:ROOT
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 872
Mailing Address - Street 2:302 RIDGE ROAD
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-0872
Mailing Address - Country:US
Mailing Address - Phone:360-832-3556
Mailing Address - Fax:
Practice Address - Street 1:211 RAINIER AVE N.
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328
Practice Address - Country:US
Practice Address - Phone:360-879-1800
Practice Address - Fax:360-879-1812
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASP 602231402355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant