Provider Demographics
NPI:1639310972
Name:GRANGER, DIANA CAROL (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CAROL
Last Name:GRANGER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 FALMOUTH WOODS RD
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-7919
Mailing Address - Country:US
Mailing Address - Phone:508-540-5846
Mailing Address - Fax:
Practice Address - Street 1:65 CORDAGE PARK CIR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7322
Practice Address - Country:US
Practice Address - Phone:508-747-4720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2762235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist