Provider Demographics
NPI:1508143397
Name:KEISER, DIANE LEA (MS,CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LEA
Last Name:KEISER
Suffix:
Gender:F
Credentials:MS,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 NW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-4849
Mailing Address - Country:US
Mailing Address - Phone:541-921-0051
Mailing Address - Fax:
Practice Address - Street 1:1807 NW 39TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-4849
Practice Address - Country:US
Practice Address - Phone:541-921-0051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11195235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist