MEDICARE: DIANE B. HOLUB M. ED. 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
1	235Z00000X	Speech-Language Pathologist	12917	TX

General Provider Information

NPI Number	:	1891012001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE B. HOLUB M. ED. CCC-SLP

Provider Business Mailing Address
First Line	:	3323 CINCO LAKES DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-5779
Country	:	US
Telephone Number	:	281-693-4626
Fax Number	:

Provider Business Practice Location Address
First Line	:	14515 BRIARHILLS PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-1000
Country	:	US
Telephone Number	:	713-575-2000
Fax Number	:	855-618-1205

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

Provider Enumeration Date	:	04/27/2010
Last Update Date	:	07/03/2014

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