Provider Demographics
NPI:1184867863
Name:LEVINTHAL, DIANE (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:LEVINTHAL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1155 BROADWAY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-3187
Mailing Address - Country:US
Mailing Address - Phone:650-533-8533
Mailing Address - Fax:650-599-9063
Practice Address - Street 1:1155 BROADWAY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-3187
Practice Address - Country:US
Practice Address - Phone:650-533-8533
Practice Address - Fax:650-599-9063
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 12678235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist