Provider Demographics
NPI:1699507202
Name:BRICKER, DIANE JOHNSTON (MSED, CPRS)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:JOHNSTON
Last Name:BRICKER
Suffix:
Gender:F
Credentials:MSED, CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 PADDOCK CT STE 3
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1370
Mailing Address - Country:US
Mailing Address - Phone:740-363-1619
Mailing Address - Fax:
Practice Address - Street 1:241 PADDOCK CT STE 3
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1370
Practice Address - Country:US
Practice Address - Phone:740-363-1619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS003621172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker