| Doctor Name: | DIANE TODD |
| NPI Number: | 1225083090 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 1139 |
| Business Practice Address: | 57950 Leavenworth St 22d Medical Group Mcconnell Afb, KS - 672213506 |
| Business Phone Number: | 3167595091 |
| Business Fax Number: | 3167591304 |
| Mailing Address: | 57950 Leavenworth St, 22d Medical Group MCCONNELL AFB |
| State: | KS |
| Postal Code: | 672213506 |
| Phone Number: | 3167595091 |
| Fax Number: | 3167591304 |
| NPI Enumeration Date: | 05/23/2006 |
| NPI Last Update Date: | 10/05/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 1139 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |