Provider Demographics
NPI:1497131544
Name:KEDZIERSKI, DIANE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:M
Last Name:KEDZIERSKI
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 1:10768 SW 67TH TER
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-4761
Mailing Address - Country:US
Mailing Address - Phone:352-300-0321
Mailing Address - Fax:352-509-4257
Practice Address - Street 1:10768 SW 67TH TER
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-4761
Practice Address - Country:US
Practice Address - Phone:352-300-0321
Practice Address - Fax:352-509-4257
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDB1-0011401103T00000X
FLPY9729103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist