Provider Demographics
NPI:1700441722
Name:MOREAN, DIANE F (PHD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:F
Last Name:MOREAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 N MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5214
Mailing Address - Country:US
Mailing Address - Phone:847-644-2594
Mailing Address - Fax:
Practice Address - Street 1:1161 MCHENRY RD STE 201
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1373
Practice Address - Country:US
Practice Address - Phone:847-383-5589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.005237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist