Provider Demographics
NPI:1801047386
Name:HEATH, DIANNE G (AUD)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:G
Last Name:HEATH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 NW LOVEJOY
Mailing Address - Street 2:#607
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-5104
Mailing Address - Country:US
Mailing Address - Phone:503-222-3638
Mailing Address - Fax:503-223-5139
Practice Address - Street 1:2222 NW LOVEJOY
Practice Address - Street 2:#607
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5104
Practice Address - Country:US
Practice Address - Phone:503-222-3638
Practice Address - Fax:503-223-5139
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20553231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist