Provider Demographics
NPI:1700031937
Name:KANEFSKY, DIANE G (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:G
Last Name:KANEFSKY
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 1:14 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1733
Mailing Address - Country:US
Mailing Address - Phone:516-466-2754
Mailing Address - Fax:516-466-6596
Practice Address - Street 1:14 VISTA DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1733
Practice Address - Country:US
Practice Address - Phone:516-466-2754
Practice Address - Fax:516-466-6596
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000815-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist