Provider Demographics
NPI:1790896553
Name:DIEHL, JANE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ANN
Last Name:DIEHL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 FAR HILLS AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1687
Mailing Address - Country:US
Mailing Address - Phone:937-643-1414
Mailing Address - Fax:937-294-4669
Practice Address - Street 1:2600 FAR HILLS AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-1687
Practice Address - Country:US
Practice Address - Phone:937-643-1414
Practice Address - Fax:937-294-4669
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3534103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0659667Medicaid
OH0659667Medicaid