Basic Information
| Provider Information | |||||||||
| NPI: | 1003169558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACEVEDO | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3887 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277100409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196846271 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 40 DUKE MEDICINE CIR # 1I | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277104000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196843451 | ||||||||
| FaxNumber: | 9196846271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2012 | ||||||||
| LastUpdateDate: | 04/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 146.006743 | IL | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 10568 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.