Basic Information
| Provider Information | |||||||||
| NPI: | 1598729659 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 9TH AVE | ||||||||
| Address2: | |||||||||
| City: | LEAVENWORTH | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660483657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136511331 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4101 S 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LEAVENWORTH | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660485014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136822000 | ||||||||
| FaxNumber: | 9137584280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 00149 | KS | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.