Provider Demographics
NPI:1447387709
Name:WEBB, DIANNE B (PHD)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:B
Last Name:WEBB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 TAWAS BEACH RD
Mailing Address - Street 2:
Mailing Address - City:EAST TAWAS
Mailing Address - State:MI
Mailing Address - Zip Code:48730
Mailing Address - Country:US
Mailing Address - Phone:989-362-2317
Mailing Address - Fax:989-362-2529
Practice Address - Street 1:1200 TAWAS BEACH RD
Practice Address - Street 2:
Practice Address - City:EAST TAWAS
Practice Address - State:MI
Practice Address - Zip Code:48730
Practice Address - Country:US
Practice Address - Phone:989-362-2317
Practice Address - Fax:989-362-2529
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007115103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist