Provider Demographics
NPI:1982724225
Name:SPEROFF, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SPEROFF
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 1:505 PINE NEEDLE DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2516
Mailing Address - Country:US
Mailing Address - Phone:610-363-2742
Mailing Address - Fax:
Practice Address - Street 1:900 LAWRENCE DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-3415
Practice Address - Country:US
Practice Address - Phone:610-696-8090
Practice Address - Fax:610-696-8300
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004068L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist