Provider Demographics
NPI:1942364278
Name:MILES, DIANE B (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:B
Last Name:MILES
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 WINTERSET CT
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-8945
Mailing Address - Country:US
Mailing Address - Phone:484-667-8316
Mailing Address - Fax:
Practice Address - Street 1:144 BRENNEN DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-3906
Practice Address - Country:US
Practice Address - Phone:302-454-2202
Practice Address - Fax:302-454-5427
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist