Individual
DIANA OSBORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
11104 PARKVIEW CIRCLE DR, STE 110, FORT WAYNE, IN 46845-1730
(260) 460-3203
(260) 460-3130
Mailing address
11104 PARKVIEW CIRCLE DR, STE 110, FORT WAYNE, IN 46845-1730
(260) 460-3203
(260) 460-3130
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20040538A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0968921
—
OH
05
—
200040220
—
IN
01
—
860000041
RR MEDICARE
IN
Enumeration date
06/30/2005
Last updated
12/26/2012
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