Provider Demographics
NPI:1265830699
Name:FIELDS, DIANA (MED, EDS)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 US 62
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-1619
Mailing Address - Country:US
Mailing Address - Phone:937-393-3132
Mailing Address - Fax:
Practice Address - Street 1:500 US 62
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1619
Practice Address - Country:US
Practice Address - Phone:937-393-3132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3021940103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool