Provider Demographics
NPI:1962496489
Name:HOPE, DIANA MARIE (MED CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:MARIE
Last Name:HOPE
Suffix:
Gender:F
Credentials:MED CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 TOWLER SHOALS DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6720
Mailing Address - Country:US
Mailing Address - Phone:770-554-6889
Mailing Address - Fax:
Practice Address - Street 1:149 TOWLER SHOALS DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-6720
Practice Address - Country:US
Practice Address - Phone:770-554-6889
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005382235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist