Provider Demographics
NPI:1306388756
Name:MEARNS, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MEARNS
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 1:2115 S COUNTY TRL
Mailing Address - Street 2:
Mailing Address - City:WEST KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02892-1634
Mailing Address - Country:US
Mailing Address - Phone:401-783-8568
Mailing Address - Fax:
Practice Address - Street 1:2115 S COUNTY TRL
Practice Address - Street 2:
Practice Address - City:WEST KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02892-1634
Practice Address - Country:US
Practice Address - Phone:401-783-8568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00655235Z00000X
CT003118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist