Provider Demographics
NPI:1538830179
Name:GOWATY, DIANE BETH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:BETH
Last Name:GOWATY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 NW FRESCO WAY APT 304
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-3544
Mailing Address - Country:US
Mailing Address - Phone:412-337-1063
Mailing Address - Fax:
Practice Address - Street 1:951 NW FRESCO WAY APT 304
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-3544
Practice Address - Country:US
Practice Address - Phone:412-337-1063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA18409235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist