Provider Demographics
NPI:1235557786
Name:HARMON, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:HARMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15941 HARLEM AVE # 118
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1609
Mailing Address - Country:US
Mailing Address - Phone:708-476-1581
Mailing Address - Fax:184-441-1897
Practice Address - Street 1:15941 HARLEM AVE # 118
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1609
Practice Address - Country:US
Practice Address - Phone:708-476-1581
Practice Address - Fax:844-411-8972
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.003021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist