Provider Demographics
NPI:1396451688
Name:MYERS, DIANNE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 W HIGHWAY 243
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-2023
Mailing Address - Country:US
Mailing Address - Phone:903-520-6762
Mailing Address - Fax:
Practice Address - Street 1:338 W NORTH COMMERCE ST
Practice Address - Street 2:
Practice Address - City:WILLS POINT
Practice Address - State:TX
Practice Address - Zip Code:75169-2504
Practice Address - Country:US
Practice Address - Phone:903-873-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16931235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16931OtherTEXAS LICENSURE