Provider Demographics
NPI:1326318841
Name:DRAKULIC, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:DRAKULIC
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 1:20427 HAVENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7087
Mailing Address - Country:US
Mailing Address - Phone:704-895-5048
Mailing Address - Fax:
Practice Address - Street 1:20427 HAVENVIEW DR
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-7087
Practice Address - Country:US
Practice Address - Phone:704-895-5048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2472235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist