Provider Demographics
NPI:1699175307
Name:MURPHY, DIANA RUSSELL (AUD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:RUSSELL
Last Name:MURPHY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 PEARL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1195
Mailing Address - Country:US
Mailing Address - Phone:508-588-8034
Mailing Address - Fax:508-588-5969
Practice Address - Street 1:35 PEARL ST STE 100
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2866
Practice Address - Country:US
Practice Address - Phone:508-588-8034
Practice Address - Fax:508-588-5969
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAUD00214231H00000X
MA1068231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist