Provider Demographics
NPI:1336334887
Name:DEJOSEPH, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:DEJOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:DEJOSEPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7630 S COUNTY LINE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6981
Mailing Address - Country:US
Mailing Address - Phone:630-321-3555
Mailing Address - Fax:630-908-5159
Practice Address - Street 1:7630 S COUNTY LINE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-6981
Practice Address - Country:US
Practice Address - Phone:630-321-3555
Practice Address - Fax:630-908-5159
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000307231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist