Provider Demographics
NPI:1356670608
Name:THE PENNSYLVANIA STATE UNIVERSITY
Entity Type:Organization
Organization Name:THE PENNSYLVANIA STATE UNIVERSITY
Other - Org Name:SPEECH AND HEARING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPARTMENT HEAD
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:814-865-3177
Mailing Address - Street 1:110 FORD BLDG
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:16802-3000
Mailing Address - Country:US
Mailing Address - Phone:814-865-5414
Mailing Address - Fax:814-863-3759
Practice Address - Street 1:110 FORD BLDG
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802-3000
Practice Address - Country:US
Practice Address - Phone:814-865-5414
Practice Address - Fax:814-863-3759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech