Provider Demographics
NPI:1316035462
Name:LAZER, DIANNE (MA CCCSLP COM)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:
Last Name:LAZER
Suffix:
Gender:F
Credentials:MA CCCSLP COM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 OLD MARLTON PIKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3196
Mailing Address - Country:US
Mailing Address - Phone:856-983-6160
Mailing Address - Fax:856-983-6162
Practice Address - Street 1:475 OLD MARLTON PIKE W
Practice Address - Street 2:SUITE 1
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2098
Practice Address - Country:US
Practice Address - Phone:856-983-6160
Practice Address - Fax:856-983-6162
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL002933L235Z00000X
NJ41YS00164900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist