Provider Demographics
NPI:1821050691
Name:SOWERS, DIANA LYNN (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:SOWERS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 N GRANT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-1768
Mailing Address - Country:US
Mailing Address - Phone:833-432-7589
Mailing Address - Fax:
Practice Address - Street 1:62 N GRANT AVE STE 101
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-1768
Practice Address - Country:US
Practice Address - Phone:833-432-7589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002618A237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000352569OtherBLUE CROSS BLUE SHIELD
IN200454890Medicaid
IN000001004875OtherANTHEM BCBS
IN218960BMedicare PIN