Provider Demographics
NPI:1205981891
Name:ROZA, DIANE MARGARET (MED, CAGS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARGARET
Last Name:ROZA
Suffix:
Gender:F
Credentials:MED, CAGS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-6002
Mailing Address - Country:US
Mailing Address - Phone:207-797-8255
Mailing Address - Fax:207-797-5560
Practice Address - Street 1:222 AUBURN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6002
Practice Address - Country:US
Practice Address - Phone:207-797-8255
Practice Address - Fax:207-797-5560
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP#1950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1228OtherSTATE OF MASS
MESP#1950OtherSTATE OF MAINE