Provider Demographics
NPI:1407271265
Name:ESPINOSA, DIANE CLARE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:CLARE
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 BLACKBURN CT.
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518
Mailing Address - Country:US
Mailing Address - Phone:907-231-5885
Mailing Address - Fax:
Practice Address - Street 1:708 BLACKBURN CT.
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518
Practice Address - Country:US
Practice Address - Phone:907-231-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK465235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist