Provider Demographics
NPI:1871569160
Name:TART, DIANNE (MS,CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:
Last Name:TART
Suffix:
Gender:F
Credentials:MS,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:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27863-0362
Mailing Address - Country:US
Mailing Address - Phone:919-739-0047
Mailing Address - Fax:919-739-9041
Practice Address - Street 1:600 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3143
Practice Address - Country:US
Practice Address - Phone:919-739-0047
Practice Address - Fax:919-739-9041
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2446235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412136Medicaid
NC136U9OtherBCBS INDIVIDUAL