Provider Demographics
NPI:1932703337
Name:POLIUK, DIANA EMILY (MA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:EMILY
Last Name:POLIUK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:GOROSHKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4700 MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-1166
Mailing Address - Country:US
Mailing Address - Phone:330-896-9119
Mailing Address - Fax:
Practice Address - Street 1:4700 MASSILLON RD
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1166
Practice Address - Country:US
Practice Address - Phone:330-896-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20201333-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist