Provider Demographics
NPI:1467736629
Name:PHILLIPS, DIANE C (AUD, MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:AUD, MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 MAHEJAN CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5500
Mailing Address - Country:US
Mailing Address - Phone:281-489-6104
Mailing Address - Fax:
Practice Address - Street 1:18200 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1285
Practice Address - Country:US
Practice Address - Phone:832-227-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50818231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist