Provider Demographics
NPI:1487673810
Name:CLEMENTS, DIANE STANLEY (MS,CGC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:STANLEY
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:MS,CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20900 ALMAR DR
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3811
Mailing Address - Country:US
Mailing Address - Phone:216-491-0955
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:NE5
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-445-0839
Practice Address - Fax:216-445-6935
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS