MEDICARE: DIANA HARMON

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	146.003021	IL

General Provider Information

NPI Number	:	1235557786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA HARMON

Provider Business Mailing Address
First Line	:	15941 HARLEM AVE # 118
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60477-1609
Country	:	US
Telephone Number	:	708-476-1581
Fax Number	:	184-441-1897

Provider Business Practice Location Address
First Line	:	15941 HARLEM AVE # 118
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60477-1609
Country	:	US
Telephone Number	:	708-476-1581
Fax Number	:	844-411-8972

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

Provider Enumeration Date	:	04/02/2014
Last Update Date	:	03/23/2017

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Directions to “ DIANA HARMON ” Practice Location

Language	Start Address	Practice Location

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