Provider Demographics
NPI:1871961649
Name:FOX, DIANE CHIAPPETTA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:CHIAPPETTA
Last Name:FOX
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 1:40 BONWIT RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1215
Mailing Address - Country:US
Mailing Address - Phone:203-698-2164
Mailing Address - Fax:
Practice Address - Street 1:40 BONWIT RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-1215
Practice Address - Country:US
Practice Address - Phone:203-698-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002379235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist