Provider Demographics
NPI:1508893603
Name:SMITH, DIANNA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:MARIE
Last Name:SMITH
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 1:187 WESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-8033
Mailing Address - Country:US
Mailing Address - Phone:435-632-5626
Mailing Address - Fax:
Practice Address - Street 1:1067 E TABERNACLE ST
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3194
Practice Address - Country:US
Practice Address - Phone:435-634-7608
Practice Address - Fax:435-584-2592
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT108036-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist