Provider Demographics
NPI:1811090871
Name:HARRISON, DIANN M (MA CCCA)
Entity type:Individual
Prefix:MRS
First Name:DIANN
Middle Name:M
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 W CENTRAL AVE
Mailing Address - Street 2:134
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606
Mailing Address - Country:US
Mailing Address - Phone:419-534-3111
Mailing Address - Fax:419-534-3113
Practice Address - Street 1:3450 W CENTRAL AVE
Practice Address - Street 2:134
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-534-3111
Practice Address - Fax:419-534-3113
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00611231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0915102Medicaid
HA0886271Medicare ID - Type Unspecified
OH0915102Medicaid