Provider Demographics
NPI:1982122636
Name:MCCARTHY, DIANE LEONE (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LEONE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5N936 CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-8234
Mailing Address - Country:US
Mailing Address - Phone:630-440-0037
Mailing Address - Fax:
Practice Address - Street 1:5N936 CASTLE DR
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-8234
Practice Address - Country:US
Practice Address - Phone:630-440-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty