Provider Demographics
NPI:1376659185
Name:THEOKAS, DIANNA LYNN (AUD)
Entity Type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:LYNN
Last Name:THEOKAS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1007
Mailing Address - Country:US
Mailing Address - Phone:716-672-9203
Mailing Address - Fax:
Practice Address - Street 1:3306 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1723
Practice Address - Country:US
Practice Address - Phone:716-874-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002070-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist