Provider Demographics
NPI:1639914930
Name:MERKEL, DIANE LYNETTE
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LYNETTE
Last Name:MERKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 OAK ST
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MI
Mailing Address - Zip Code:49078-9318
Mailing Address - Country:US
Mailing Address - Phone:269-355-8577
Mailing Address - Fax:
Practice Address - Street 1:102 W 11TH AVE STE A
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9255
Practice Address - Country:US
Practice Address - Phone:208-981-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61558792235Z00000X
MI0653496235Z00000X
IDSLP-6418235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist