Provider Demographics
NPI:1699843607
Name:BRYANT, DIANE HOLDEN (MS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:HOLDEN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHILDREN'S MEMORIAL HOSPITAL
Mailing Address - Street 2:2300 CHILDREN'S PLAZA #38
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3394
Mailing Address - Country:US
Mailing Address - Phone:773-880-4530
Mailing Address - Fax:773-880-6618
Practice Address - Street 1:CHILDREN'S MEMORIAL HOSPITAL
Practice Address - Street 2:2300 CHILDREN'S PLAZA #38
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3394
Practice Address - Country:US
Practice Address - Phone:773-880-4530
Practice Address - Fax:773-880-6618
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12400141231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist