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NPI Code Detail

MEDICARE: MS. DIANE THERESA GRAFF M.A., CCC-SLP

MEDICARE: MS. DIANE THERESA GRAFF M.A., 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
1235Z00000XSpeech-Language Pathologist004124-1NY

General Provider Information

NPI Number : 1255768016
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DIANE THERESA GRAFF M.A., CCC-SLP
Provider Business Mailing Address
First Line : 19665 69TH AVE
Second Line : #1
City : FRESH MEADOWS
State : NY
Zip : 11365-4032
Country : US
Telephone Number : 718-454-7277
Fax Number :
Provider Business Practice Location Address
First Line : 18302 UNION TPKE
Second Line :
City : FLUSHING
State : NY
Zip : 11366-1623
Country : US
Telephone Number : 718-969-3944
Fax Number : 718-969-4073
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2013
Last Update Date : 10/10/2013

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