Provider Demographics
NPI:1326271172
Name:MILANESE, DIANE ALANE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ALANE
Last Name:MILANESE
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 1:441 CONNIE STREET
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527
Mailing Address - Country:US
Mailing Address - Phone:913-963-3204
Mailing Address - Fax:
Practice Address - Street 1:441 CONNIE ST
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:WI
Practice Address - Zip Code:53527-9613
Practice Address - Country:US
Practice Address - Phone:913-963-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00019235Z00000X
MO107509235Z00000X
235Z00000X
WI4257-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist