Provider Demographics
NPI:1427538958
Name:DIAZ, VIANNEY CECILIA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VIANNEY
Middle Name:CECILIA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 MANCHACA RD APT 147
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6710
Mailing Address - Country:US
Mailing Address - Phone:214-405-1470
Mailing Address - Fax:
Practice Address - Street 1:4005 BANISTER LN STE 180C
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8077
Practice Address - Country:US
Practice Address - Phone:512-615-9004
Practice Address - Fax:512-615-9005
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist