Provider Demographics
NPI:1508019589
Name:VACCARO, DIANA (SLP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:VACCARO
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 1:20615 FAWNBROOK CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-8548
Mailing Address - Country:US
Mailing Address - Phone:646-645-2001
Mailing Address - Fax:281-829-7897
Practice Address - Street 1:20615 FAWNBROOK CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-8548
Practice Address - Country:US
Practice Address - Phone:646-645-2001
Practice Address - Fax:281-829-7897
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014088-1235Z00000X
TX104913235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist