Provider Demographics
NPI:1750467130
Name:KERN, DIANE PRISCILLA
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:PRISCILLA
Last Name:KERN
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 1:27 N BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:DILLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17019-1211
Mailing Address - Country:US
Mailing Address - Phone:717-432-4337
Mailing Address - Fax:
Practice Address - Street 1:27 N BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:DILLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17019-1211
Practice Address - Country:US
Practice Address - Phone:717-432-4337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000892L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019166860003OtherMA PROMISE