Provider Demographics
NPI:1932200722
Name:DIANA G. MASKER, M.A., CCC
Entity type:Organization
Organization Name:DIANA G. MASKER, M.A., CCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MASKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC
Authorized Official - Phone:321-751-1443
Mailing Address - Street 1:3040 N WICKHAM RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2369
Mailing Address - Country:US
Mailing Address - Phone:321-751-1443
Mailing Address - Fax:321-751-1448
Practice Address - Street 1:3040 N WICKHAM RD
Practice Address - Street 2:SUITE 4
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2369
Practice Address - Country:US
Practice Address - Phone:321-751-1443
Practice Address - Fax:321-751-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 3134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS2743OtherBC/BS PROVIDER ID
FLS2743OtherBC/BS PROVIDER ID