Provider Demographics
NPI:1285222893
Name:SMITH, DIANA A (MA-CCC,SLP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA-CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 OPAL AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2140
Mailing Address - Country:US
Mailing Address - Phone:650-759-8213
Mailing Address - Fax:
Practice Address - Street 1:184 OPAL AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2140
Practice Address - Country:US
Practice Address - Phone:650-759-8213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist