MEDICARE: MS. DIANA MARIE HOPE 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	SLP005382	GA

General Provider Information

NPI Number	:	1962496489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANA MARIE HOPE M.ED. CCC/SLP

Provider Business Mailing Address
First Line	:	149 TOWLER SHOALS DR
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-6720
Country	:	US
Telephone Number	:	770-554-6889
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 TOWLER SHOALS DR
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-6720
Country	:	US
Telephone Number	:	770-554-6889
Fax Number	:

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/08/2007

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Directions to “ MS. DIANA MARIE HOPE M.ED. CCC/SLP” Practice Location

Language	Start Address	Practice Location

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