Provider Demographics
NPI:1689825333
Name:SIMON, DIANE U (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:DIANE
Middle Name:U
Last Name:SIMON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:30 BEAVER RUN RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419
Mailing Address - Country:US
Mailing Address - Phone:973-827-6039
Mailing Address - Fax:678-867-6974
Practice Address - Street 1:30 BEAVER RUN RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NJ
Practice Address - Zip Code:07419
Practice Address - Country:US
Practice Address - Phone:973-827-6039
Practice Address - Fax:678-867-6974
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP 004978235Z00000X
NJ41YS00255000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist