MEDICARE: ACKERLEY INC.

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	103TC0700X	Clinical Psychologist	3976	OH

General Provider Information

NPI Number	:	1881717759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACKERLEY INC.

Provider Business Mailing Address
First Line	:	305 E STROOP RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-2827
Country	:	US
Telephone Number	:	937-294-1689
Fax Number	:	937-294-3320

Provider Business Practice Location Address
First Line	:	305 E STROOP RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-2827
Country	:	US
Telephone Number	:	937-294-1689
Fax Number	:	937-294-3320

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DIANA GUARNERA ACKERLEY
Credential	:	PH.D.
Telephone Number	:	937-294-1689

Provider Enumeration Date	:	04/07/2007
Last Update Date	:	08/22/2020

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