Provider Demographics
NPI:1184131724
Name:KIRKPATRICK, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W PADRE ST STE F
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3960
Mailing Address - Country:US
Mailing Address - Phone:805-729-1992
Mailing Address - Fax:
Practice Address - Street 1:123 W PADRE ST STE F
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3960
Practice Address - Country:US
Practice Address - Phone:805-729-1992
Practice Address - Fax:805-729-1992
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1385235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist