Provider Demographics
NPI:1124287925
Name:MARSH, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MARSH
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:PO BOX 3313
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-3313
Mailing Address - Country:US
Mailing Address - Phone:907-283-7946
Mailing Address - Fax:
Practice Address - Street 1:150 N WILLOW ST
Practice Address - Street 2:SUITE 15
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7701
Practice Address - Country:US
Practice Address - Phone:907-283-7946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK114235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist