Provider Demographics
NPI:1659507036
Name:THOMPSON, DIANA LYN (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LYN
Other - Last Name:TRINCONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:135 DELMAR AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2803
Mailing Address - Country:US
Mailing Address - Phone:718-948-5462
Mailing Address - Fax:
Practice Address - Street 1:135 DELMAR AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2803
Practice Address - Country:US
Practice Address - Phone:718-948-5462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-30
Last Update Date:2009-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014579235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist