Individual
MS. DIANA MARIE JETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., CCC SLP
Contact information
Practice address
1318 MEMORIAL DR, BRYAN, TX 77802-5215
(979) 776-2872
Mailing address
3009 RED ROBIN LOOP, BRYAN, TX 77802-3026
(979) 731-8312
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
14668
TX
Other
Enumeration date
01/08/2007
Last updated
07/08/2007
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