Provider Demographics
NPI:1740607498
Name:WEINER, DIANE
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:WEINER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15600 PARKLAND DR
Mailing Address - Street 2:15600 PARKLAND DRIVE
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2529
Mailing Address - Country:US
Mailing Address - Phone:216-295-6159
Mailing Address - Fax:
Practice Address - Street 1:15600 PARKLAND DR
Practice Address - Street 2:15600 PARKLAND DRIVE
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-2529
Practice Address - Country:US
Practice Address - Phone:216-295-6159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP1562235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist