Provider Demographics
NPI:1467736629
Name:PHILLIPS, DIANE C (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:C
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-A
Mailing Address - Street 1:4909 MAHEJAN CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5500
Mailing Address - Country:US
Mailing Address - Phone:713-204-4870
Mailing Address - Fax:
Practice Address - Street 1:250 BLOSSOM ST FL 3
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4204
Practice Address - Country:US
Practice Address - Phone:713-204-4870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50818231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist