Provider Demographics
NPI:1851690804
Name:WEST, DIANNE ELIZABETH (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:ELIZABETH
Last Name:WEST
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:MISS
Other - First Name:DIANNE
Other - Middle Name:ELIZABETH
Other - Last Name:WARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCC-SLP
Mailing Address - Street 1:193 WINFIELD ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-1500
Mailing Address - Country:US
Mailing Address - Phone:607-962-6706
Mailing Address - Fax:607-654-2848
Practice Address - Street 1:193 WINFIELD ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-1500
Practice Address - Country:US
Practice Address - Phone:607-962-6706
Practice Address - Fax:607-654-2848
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58-018687-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist