Provider Demographics
NPI:1336473909
Name:INGWERSEN, DIANNE (HIS)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:INGWERSEN
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3214
Mailing Address - Country:US
Mailing Address - Phone:781-350-3445
Mailing Address - Fax:339-221-5282
Practice Address - Street 1:3 ASHLAND ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3214
Practice Address - Country:US
Practice Address - Phone:781-350-3445
Practice Address - Fax:339-221-5282
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA132237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist