Provider Demographics
NPI:1184869851
Name:NIEBUHR, DIANE PATRICE (MA CCC-A)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:PATRICE
Last Name:NIEBUHR
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HAWKINS DRIVE
Mailing Address - Street 2:THE UNIVERSITY OF IOWA
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1012
Mailing Address - Country:US
Mailing Address - Phone:319-335-8736
Mailing Address - Fax:319-335-8851
Practice Address - Street 1:250 HAWKINS DRIVE
Practice Address - Street 2:THE UNIVERSITY OF IOWA
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1012
Practice Address - Country:US
Practice Address - Phone:319-335-8736
Practice Address - Fax:319-335-8851
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA195231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist