Provider Demographics
NPI:1952508756
Name:DUDDY, DIANE E (AUD)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:E
Last Name:DUDDY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8115
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-7489
Mailing Address - Fax:314-747-5593
Practice Address - Street 1:4921 PARKVIEW PL STE 11A
Practice Address - Street 2:STE 11A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-7489
Practice Address - Fax:314-747-5593
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00979231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1952508756Medicaid
ILENROLLEDMedicaid