Provider Demographics
NPI:1205280997
Name:DIESEL-SLONE, STEFFANI (PSY S)
Entity type:Individual
Prefix:
First Name:STEFFANI
Middle Name:
Last Name:DIESEL-SLONE
Suffix:
Gender:F
Credentials:PSY S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DONHAM PLZ FL 4
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-1932
Mailing Address - Country:US
Mailing Address - Phone:513-217-2880
Mailing Address - Fax:
Practice Address - Street 1:1 DONHAM PLZ FL 4
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-1932
Practice Address - Country:US
Practice Address - Phone:513-217-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1419084174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist