Individual
DIANE KOGLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
4 CAMELBACK RD, GREENVILLE, SC 29617-7335
(864) 434-1228
Mailing address
4 CAMELBACK RD, GREENVILLE, SC 29617-7335
(864) 434-1228
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
1601000077
MI
237600000X
Audiologist-Hearing Aid Fitter
Primary
3930
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000551641
BCBS
SC
01
—
54-0-C2-0269
BCBS/DISPENSING
MI
01
—
64-0-C2-2601
BCBS/TESTING
MI
01
—
Q373590281
MEDICARE
SC
05
—
SA1394
—
SC
Enumeration date
11/01/2006
Last updated
05/02/2018
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