Provider Demographics
NPI:1174750434
Name:REESE, DIANA LUCILE (MS)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LUCILE
Last Name:REESE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 MURRAY HOLLADAY RD APT 9
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4967
Mailing Address - Country:US
Mailing Address - Phone:801-875-2094
Mailing Address - Fax:
Practice Address - Street 1:3845 W 4700 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-3454
Practice Address - Country:US
Practice Address - Phone:801-840-4360
Practice Address - Fax:801-840-4399
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7697722-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist