=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275837429
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALYSON DIAZ-KLEINE M.S., CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2011
-----------------------------------------------------
Last Update Date | 01/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10094 LITZSINGER RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63124-1132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-989-8869
-----------------------------------------------------
Fax | 314-989-8870
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 KLEIN CT
-----------------------------------------------------
City | COLLINSVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62234-3751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-989-8869
-----------------------------------------------------
Fax | 314-989-8870
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 1999137418
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------