Provider Demographics
NPI:1568465128
Name:BLAISING, DIANE G (AUD, FAAA, CCC-A)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:G
Last Name:BLAISING
Suffix:
Gender:F
Credentials:AUD, FAAA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 OAKMONT BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4204
Mailing Address - Country:US
Mailing Address - Phone:817-263-1800
Mailing Address - Fax:817-263-1802
Practice Address - Street 1:7801 OAKMONT BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4204
Practice Address - Country:US
Practice Address - Phone:817-263-1800
Practice Address - Fax:817-263-1802
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51489237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS48150Medicare UPIN