Provider Demographics
NPI:1750078796
Name:HERNANDEZ, DIANA P (CCC-SLP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:P
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 29TH PL
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2941
Mailing Address - Country:US
Mailing Address - Phone:708-829-4395
Mailing Address - Fax:
Practice Address - Street 1:7015 29TH PL
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2941
Practice Address - Country:US
Practice Address - Phone:708-829-4395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist