Provider Demographics
NPI:1427576263
Name:SPRINGSTEAD, DIANA LYNN
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:SPRINGSTEAD
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:PO BOW 674
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443
Mailing Address - Country:US
Mailing Address - Phone:231-343-8381
Mailing Address - Fax:
Practice Address - Street 1:1160 RANSOM ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3322
Practice Address - Country:US
Practice Address - Phone:231-343-8381
Practice Address - Fax:231-343-8381
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty