Provider Demographics
NPI:1992837595
Name:BLOCH-KELL, DIANE (SLP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:BLOCH-KELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3746 NW 61ST PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-0832
Mailing Address - Country:US
Mailing Address - Phone:352-214-8310
Mailing Address - Fax:352-376-0126
Practice Address - Street 1:120 NW 28TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2511
Practice Address - Country:US
Practice Address - Phone:352-246-5384
Practice Address - Fax:352-376-0126
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885505600Medicaid