Provider Demographics
NPI:1477863124
Name:WARMING, DIANE L (SLP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:WARMING
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 CONCORD ST W
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2501
Mailing Address - Country:US
Mailing Address - Phone:207-615-5405
Mailing Address - Fax:
Practice Address - Street 1:255 CONCORD ST W
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2501
Practice Address - Country:US
Practice Address - Phone:207-615-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP447235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MESP447OtherSTATE LICENSE
ME230980099Medicaid