Provider Demographics
NPI:1255768016
Name:GRAFF, DIANE THERESA (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:THERESA
Last Name:GRAFF
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 1:19665 69TH AVE
Mailing Address - Street 2:#1
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-4032
Mailing Address - Country:US
Mailing Address - Phone:718-454-7277
Mailing Address - Fax:
Practice Address - Street 1:18302 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11366-1623
Practice Address - Country:US
Practice Address - Phone:718-969-3944
Practice Address - Fax:718-969-4073
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004124-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist