Provider Demographics
NPI:1154534386
Name:SPEAKMAN, DIANNE (SLP)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:
Last Name:SPEAKMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:DR
Other - First Name:DIANNE
Other - Middle Name:
Other - Last Name:SPEAKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLPD
Mailing Address - Street 1:309 BRITTANY DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3286
Mailing Address - Country:US
Mailing Address - Phone:973-694-1698
Mailing Address - Fax:
Practice Address - Street 1:301 SICOMAC AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2159
Practice Address - Country:US
Practice Address - Phone:201-848-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ883235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist