Provider Demographics
NPI:1417337858
Name:WELDON, DIANE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:WELDON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2426 LA LOMA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-3413
Mailing Address - Country:US
Mailing Address - Phone:916-205-5792
Mailing Address - Fax:
Practice Address - Street 1:2530 DOUGLAS BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3989
Practice Address - Country:US
Practice Address - Phone:916-797-3307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22984235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist