Provider Demographics
NPI:1053568840
Name:BARBER, DIANA L
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:L
Last Name:BARBER
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 1:4413 E SHELBY RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-9787
Mailing Address - Country:US
Mailing Address - Phone:585-798-1243
Mailing Address - Fax:
Practice Address - Street 1:4413 E SHELBY RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-9787
Practice Address - Country:US
Practice Address - Phone:585-798-1243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005225-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist