Healthcare Provider Details

I. General information

NPI: 1952763492
Provider Name (Legal Business Name): DIANA KUYKENDALL MS,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 SE INTERNATIONAL WAY STE 100
MILWAUKIE OR
97222-4628
US

IV. Provider business mailing address

90 HEAVENS VIEW RD
WAYNESVILLE NC
28786-8708
US

V. Phone/Fax

Practice location:
  • Phone: 828-648-2044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8033
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: