Provider Demographics
NPI:1982683710
Name:LUTHER, DIANE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:LUTHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 2ND ST SE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-1201
Mailing Address - Country:US
Mailing Address - Phone:319-362-0632
Mailing Address - Fax:319-362-5206
Practice Address - Street 1:118 2ND ST SE
Practice Address - Street 2:SUITE 220
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1201
Practice Address - Country:US
Practice Address - Phone:319-362-0632
Practice Address - Fax:319-362-5206
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00708103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
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IAV552DMedicare UPIN
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IAI12263Medicare ID - Type UnspecifiedMEDICARE B