Provider Demographics
NPI:1548488760
Name:MIREK, DIANA (SP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MIREK
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:KIEHFUSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2316 N STATE ROUTE 721
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45308-9544
Mailing Address - Country:US
Mailing Address - Phone:937-548-9495
Mailing Address - Fax:937-548-3055
Practice Address - Street 1:1498 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-2454
Practice Address - Country:US
Practice Address - Phone:937-548-9495
Practice Address - Fax:937-548-3055
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist