Provider Demographics
NPI:1437564598
Name:CHRISTIANA, DIANA (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CHRISTIANA
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 COPPERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-6580
Mailing Address - Country:US
Mailing Address - Phone:713-206-8687
Mailing Address - Fax:
Practice Address - Street 1:14100 SOUTHWEST FWY
Practice Address - Street 2:SUITE #360
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3466
Practice Address - Country:US
Practice Address - Phone:281-275-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist