Provider Demographics
NPI:1548591282
Name:DIAZ, REBECCA ANNA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 E AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-5160
Mailing Address - Country:US
Mailing Address - Phone:210-363-7058
Mailing Address - Fax:
Practice Address - Street 1:302 LORENALY DR
Practice Address - Street 2:STE D
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4331
Practice Address - Country:US
Practice Address - Phone:956-350-6696
Practice Address - Fax:956-350-6604
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105653235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist