Provider Demographics
NPI:1487934907
Name:STOLL, DIANE (SLP)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:STOLL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 RUSKIN RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4257
Mailing Address - Country:US
Mailing Address - Phone:716-834-1811
Mailing Address - Fax:
Practice Address - Street 1:10150 GREINER RD
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1375
Practice Address - Country:US
Practice Address - Phone:716-407-9206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005738-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist