MEDICARE: DIANE C GUPTA CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	112035	MO
2	235Z00000X	Speech-Language Pathologist	2602	KS

General Provider Information

NPI Number	:	1053449090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE C GUPTA CCC-SLP

Provider Business Mailing Address
First Line	:	8634 MAIDEN LN
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-3033
Country	:	US
Telephone Number	:	816-363-6259
Fax Number	:

Provider Business Practice Location Address
First Line	:	8634 MAIDEN LN
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-3033
Country	:	US
Telephone Number	:	816-363-6259
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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Directions to “ DIANE C GUPTA CCC-SLP” Practice Location

Language	Start Address	Practice Location

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