Provider Demographics
NPI:1619225851
Name:WEISENBERGER, DIANE (AUD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:WEISENBERGER
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 1:8100 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2900
Mailing Address - Country:US
Mailing Address - Phone:215-535-5598
Mailing Address - Fax:
Practice Address - Street 1:8100 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2900
Practice Address - Country:US
Practice Address - Phone:215-535-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006266231H00000X
NJ41YA00083600231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist