Provider Demographics
NPI:1972975126
Name:FRIEDEL, DIANNE MARIE
Entity type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:MARIE
Last Name:FRIEDEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 MIDDLE GROVE ROAD
Mailing Address - Street 2:MIDDLE GROVE
Mailing Address - City:MIDDLEGROVE
Mailing Address - State:NY
Mailing Address - Zip Code:12850-1107
Mailing Address - Country:US
Mailing Address - Phone:518-810-4148
Mailing Address - Fax:518-587-1567
Practice Address - Street 1:479 MIDDLE GROVE RD
Practice Address - Street 2:
Practice Address - City:MIDDLE GROVE
Practice Address - State:NY
Practice Address - Zip Code:12850-1107
Practice Address - Country:US
Practice Address - Phone:518-810-4148
Practice Address - Fax:518-587-1567
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001100-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist