Provider Demographics
NPI:1073678322
Name:HENSLEY, DIANA (SLP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78580-0092
Mailing Address - Country:US
Mailing Address - Phone:956-689-5301
Mailing Address - Fax:
Practice Address - Street 1:100 N HWY 77 STE F
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-4009
Practice Address - Country:US
Practice Address - Phone:956-689-5301
Practice Address - Fax:956-689-2004
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15424OtherSTATE LICENSE