Provider Demographics
NPI:1386005544
Name:WACHSBERGER, DIANA (ST)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:WACHSBERGER
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7620 SOUTHERN BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5667
Mailing Address - Country:US
Mailing Address - Phone:330-955-9330
Mailing Address - Fax:330-965-9308
Practice Address - Street 1:7620 SOUTHERN BLVD
Practice Address - Street 2:STE 3
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5667
Practice Address - Country:US
Practice Address - Phone:330-955-9330
Practice Address - Fax:330-965-9308
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.10263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist