Provider Demographics
NPI:1417456765
Name:WARDEN, MARY DIANE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DIANE
Last Name:WARDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 BARRANCA PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1721
Mailing Address - Country:US
Mailing Address - Phone:949-857-6051
Mailing Address - Fax:949-857-0941
Practice Address - Street 1:4010 BARRANCA PKWY STE 220
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1721
Practice Address - Country:US
Practice Address - Phone:949-857-6051
Practice Address - Fax:949-857-0941
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP5962235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist