Provider Demographics
NPI:1215060868
Name:WATERMAN, DIANE T
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:T
Last Name:WATERMAN
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 1:2561 OAK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1840
Mailing Address - Country:US
Mailing Address - Phone:615-482-3253
Mailing Address - Fax:
Practice Address - Street 1:4731 TROUSDALE DR STE 13A
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-1331
Practice Address - Country:US
Practice Address - Phone:615-482-3253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000772235Z00000X
TN0772235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist