Provider Demographics
NPI:1427388222
Name:AU, DIANA BETH (CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:BETH
Last Name:AU
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 1:231 MARYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4833
Mailing Address - Country:US
Mailing Address - Phone:909-624-0405
Mailing Address - Fax:
Practice Address - Street 1:6400 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1571
Practice Address - Country:US
Practice Address - Phone:909-624-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist