Provider Demographics
NPI:1598161440
Name:CHAN, DIONA MARIE
Entity Type:Individual
Prefix:
First Name:DIONA MARIE
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9891 BROKEN LAND PKWY
Mailing Address - Street 2:SUITE 306
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1165
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9891 BROKEN LAND PKWY
Practice Address - Street 2:SUITE 306
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1165
Practice Address - Country:US
Practice Address - Phone:866-566-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14060670235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist