MEDICARE: DR. DIANE GASKIN PH.D

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	103TS0200X	School Psychologist	3493	NC

General Provider Information

NPI Number	:	1609997097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE GASKIN PH.D

Provider Business Mailing Address
First Line	:	PO BOX 5441
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-1507
Country	:	US
Telephone Number	:	704-796-7734
Fax Number	:

Provider Business Practice Location Address
First Line	:	1914 J N PEASE PL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4504
Country	:	US
Telephone Number	:	704-796-7734
Fax Number	:

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	09/09/2008

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