Provider Demographics
NPI:1558088526
Name:PRUS, DIAMOND G (AUD)
Entity Type:Individual
Prefix:
First Name:DIAMOND
Middle Name:G
Last Name:PRUS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 KING JAMES CT
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-4730
Mailing Address - Country:US
Mailing Address - Phone:847-571-1923
Mailing Address - Fax:
Practice Address - Street 1:500 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1239
Practice Address - Country:US
Practice Address - Phone:410-778-5170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006858231H00000X
MD01617231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist