Healthcare Provider Details

I. General information

NPI: 1073418802
Provider Name (Legal Business Name): DIAMOND LAUDERDALE M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2026
Last Update Date: 10/12/2026
Certification Date: 10/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 CHALKER ST
AKRON OH
44310-2137
US

IV. Provider business mailing address

880 CHALKER ST
AKRON OH
44310-2137
US

V. Phone/Fax

Practice location:
  • Phone: 234-263-8865
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: