Provider Demographics
NPI:1316492275
Name:POLLEDRI, DIANE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:POLLEDRI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MOUNTAINVIEW RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2308
Mailing Address - Country:US
Mailing Address - Phone:973-571-1585
Mailing Address - Fax:
Practice Address - Street 1:1515 BROAD ST
Practice Address - Street 2:MSU-CASLP
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3002
Practice Address - Country:US
Practice Address - Phone:973-655-7946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00086900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist