Provider Demographics
NPI:1891846051
Name:DIETZ, DIANA L (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:DIETZ
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 1:5 EKES CT
Mailing Address - Street 2:SUSSEX
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-4900
Mailing Address - Country:US
Mailing Address - Phone:973-702-1447
Mailing Address - Fax:
Practice Address - Street 1:75 CRYSTAL RUN RD BLDG B
Practice Address - Street 2:MIDDLETOWN
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-7000
Practice Address - Country:US
Practice Address - Phone:888-350-1368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYA000296231H00000X
NY57 002205231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist