Provider Demographics
NPI:1033290085
Name:DIAZ, JENNIFER CAMPBELL (M ED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAMPBELL
Last Name:DIAZ
Suffix:
Gender:F
Credentials:M ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 E WOODLAWN RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-2202
Mailing Address - Country:US
Mailing Address - Phone:704-523-8027
Mailing Address - Fax:704-523-8031
Practice Address - Street 1:210 E WOODLAWN RD
Practice Address - Street 2:SUITE 150
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-2202
Practice Address - Country:US
Practice Address - Phone:704-523-8027
Practice Address - Fax:704-523-8031
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC6023235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist