Provider Demographics
NPI:1235584202
Name:JASKI, DIANA (HIS)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:JASKI
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 W SAINT GERMAIN ST
Mailing Address - Street 2:STE 203
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4121
Mailing Address - Country:US
Mailing Address - Phone:320-654-0505
Mailing Address - Fax:800-257-4057
Practice Address - Street 1:1411 W SAINT GERMAIN ST
Practice Address - Street 2:STE 203
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4121
Practice Address - Country:US
Practice Address - Phone:320-654-0505
Practice Address - Fax:800-257-4057
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2785237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist