Provider Demographics
NPI:1497076764
Name:SIMPSON, DIANE (EDD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 179TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-2916
Mailing Address - Country:US
Mailing Address - Phone:708-957-0563
Mailing Address - Fax:708-957-0563
Practice Address - Street 1:4920 179TH ST
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-2916
Practice Address - Country:US
Practice Address - Phone:708-957-0563
Practice Address - Fax:708-957-0563
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist