Provider Demographics
NPI:1790109270
Name:BERTUZZI, DIANNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:BERTUZZI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 ROYAL WOODS DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8670
Mailing Address - Country:US
Mailing Address - Phone:330-334-7387
Mailing Address - Fax:
Practice Address - Street 1:741 WINKLER DR
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1652
Practice Address - Country:US
Practice Address - Phone:330-345-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6786235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist