# SHANA DIAMOND SLP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558881912
- **Authorized official:** SHANA I DIAMOND M.S. CCC-SLP (SPEECH-LANGUAGE PATHOLOGIST)
- **Authorized official phone:** (224) 436-2508

## Contact information

- **Practice address:** 1520 W SAND BAR CT UNIT 1A, ROUND LAKE BEACH, IL 60073-4657
- **Practice address phone:** (224) 436-2508
- **Mailing address:** 1520 W SAND BAR CT UNIT 1A, ROUND LAKE BEACH, IL 60073-4657
- **Mailing address phone:** (224) 436-2508

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 235Z00000X | Speech-Language Pathologist | 146013335 | IL | Yes |

## Other

- **Enumeration date:** 06/26/2017
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 146013335 | SPEECH-LANGUAGE PATHOLOGIST | IL |