Provider Demographics
NPI:1962533968
Name:DIEBOLD, WENDY F (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:F
Last Name:DIEBOLD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 OLD DOMINION DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-4818
Mailing Address - Country:US
Mailing Address - Phone:412-973-7599
Mailing Address - Fax:412-373-2883
Practice Address - Street 1:2124 OLD DOMINION DR
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-4818
Practice Address - Country:US
Practice Address - Phone:412-973-7599
Practice Address - Fax:412-373-2883
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA235Z00000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00519694-02OtherASHA LICENSE
PASL000085LOtherPA. STATE LICENSE