Provider Demographics
NPI:1053946145
Name:GORMAN, DIANE E (MA IN SPEECH LANG)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:E
Last Name:GORMAN
Suffix:
Gender:F
Credentials:MA IN SPEECH LANG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 S LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-2415
Mailing Address - Country:US
Mailing Address - Phone:816-380-2727
Mailing Address - Fax:
Practice Address - Street 1:503 S LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-2415
Practice Address - Country:US
Practice Address - Phone:816-389-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist