MEDICARE: MS. RHONDA CARLA DIENER MA 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	000298	NY

General Provider Information

NPI Number	:	1922253061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RHONDA CARLA DIENER MA CCC/SLP

Provider Business Mailing Address
First Line	:	8115 164TH ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-1118
Country	:	US
Telephone Number	:	718-380-3000
Fax Number	:	718-380-3214

Provider Business Practice Location Address
First Line	:	8225 164TH ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-1120
Country	:	US
Telephone Number	:	718-374-0002
Fax Number	:	718-380-3214

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

Provider Enumeration Date	:	11/17/2008
Last Update Date	:	11/17/2008

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