Provider Demographics
NPI:1518999606
Name:LYONS, DIANE CONDON (MSCCC/A)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:CONDON
Last Name:LYONS
Suffix:
Gender:F
Credentials:MSCCC/A
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:CONDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 CONGRESS ST
Mailing Address - Street 2:2J
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0908
Mailing Address - Country:US
Mailing Address - Phone:617-479-7503
Mailing Address - Fax:
Practice Address - Street 1:500 CONGRESS ST
Practice Address - Street 2:2J
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0908
Practice Address - Country:US
Practice Address - Phone:617-479-7503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA443231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5102286Medicaid
MALY012964Medicare PIN