Provider Demographics
NPI:1255538419
Name:AEY, DIANA J (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:J
Last Name:AEY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-2313
Mailing Address - Country:US
Mailing Address - Phone:330-794-8893
Mailing Address - Fax:
Practice Address - Street 1:2714 13TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-3121
Practice Address - Country:US
Practice Address - Phone:330-456-2842
Practice Address - Fax:330-456-5343
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6783235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist