Provider Demographics
NPI:1699106146
Name:NELSON, DIANA BUKSDORF (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:BUKSDORF
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3160 CENTRAL PARK W
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1083
Mailing Address - Country:US
Mailing Address - Phone:419-841-1840
Mailing Address - Fax:419-841-1841
Practice Address - Street 1:3901 BEAUBIEN BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-8903
Practice Address - Fax:313-966-2694
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI7101004450235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist