Provider Demographics
NPI:1740634583
Name:URBANSKI, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:URBANSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:GORTYCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 DRUMMOND DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-3202
Mailing Address - Country:US
Mailing Address - Phone:973-557-6029
Mailing Address - Fax:
Practice Address - Street 1:801 DRUMMOND DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-3202
Practice Address - Country:US
Practice Address - Phone:973-557-6029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00817500235Z00000X
WA61097597235Z00000X
TX116336235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85-3885354Medicaid