Provider Demographics
NPI:1629515416
Name:HERNANDEZ, DIANIRA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DIANIRA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 PRIMROSE RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2622
Mailing Address - Country:US
Mailing Address - Phone:215-290-5919
Mailing Address - Fax:
Practice Address - Street 1:3514 PRIMROSE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2622
Practice Address - Country:US
Practice Address - Phone:215-290-5919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist