Provider Demographics
NPI:1356480081
Name:REED, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21589 HIGHWAY 79
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52623-9798
Mailing Address - Country:US
Mailing Address - Phone:319-392-4176
Mailing Address - Fax:319-392-4891
Practice Address - Street 1:21589 HIGHWAY 79
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IA
Practice Address - Zip Code:52623-9798
Practice Address - Country:US
Practice Address - Phone:319-392-4176
Practice Address - Fax:319-392-4891
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00369101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor