Provider Demographics
NPI:1184901613
Name:DIBLASI, ANITA F (MA CF/SLP)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:F
Last Name:DIBLASI
Suffix:
Gender:F
Credentials:MA CF/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3248 VALLEY LN S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-3117
Mailing Address - Country:US
Mailing Address - Phone:614-209-6950
Mailing Address - Fax:
Practice Address - Street 1:50 BLYMYER AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2343
Practice Address - Country:US
Practice Address - Phone:419-775-5367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.2012157-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist