Provider Demographics
NPI:1942389374
Name:POWERS, DIANE C (PSYD, CADC)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:C
Last Name:POWERS
Suffix:
Gender:F
Credentials:PSYD, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PALM DR
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4901
Mailing Address - Country:US
Mailing Address - Phone:847-917-3839
Mailing Address - Fax:847-382-7067
Practice Address - Street 1:1580 N NORTHWEST HWY
Practice Address - Street 2:SUITE 125
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1444
Practice Address - Country:US
Practice Address - Phone:847-917-3839
Practice Address - Fax:847-382-7067
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical