Provider Demographics
NPI:1962953588
Name:JOURNEY, DIANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:JOURNEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-1641
Mailing Address - Country:US
Mailing Address - Phone:417-235-3144
Mailing Address - Fax:
Practice Address - Street 1:801 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-1641
Practice Address - Country:US
Practice Address - Phone:417-235-3144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114667235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist