Provider Demographics
NPI:1851426845
Name:MANN, DIANA J (CCCSLP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:J
Last Name:MANN
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 BROAD ST
Mailing Address - Street 2:UNIT C2
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4751
Mailing Address - Country:US
Mailing Address - Phone:203-876-2000
Mailing Address - Fax:203-876-1545
Practice Address - Street 1:101 N PLAINS INDUSTRIAL RD
Practice Address - Street 2:BUILDING 2
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2360
Practice Address - Country:US
Practice Address - Phone:203-949-9337
Practice Address - Fax:203-876-1545
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist