Provider Demographics
NPI:1558665927
Name:BREDES-NIES, DIANE ELIZABETH (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ELIZABETH
Last Name:BREDES-NIES
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-4051
Mailing Address - Country:US
Mailing Address - Phone:585-467-8816
Mailing Address - Fax:585-366-5575
Practice Address - Street 1:145 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-4051
Practice Address - Country:US
Practice Address - Phone:585-467-8816
Practice Address - Fax:585-366-5575
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003823-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist