Provider Demographics
NPI:1790171759
Name:DIAZ, JOHANNA (MS, CC-SLP)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MS, CC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 HUNGERFORD DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1718
Mailing Address - Country:US
Mailing Address - Phone:301-659-4363
Mailing Address - Fax:
Practice Address - Street 1:900 JACKSON RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2807
Practice Address - Country:US
Practice Address - Phone:301-659-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06519235Z00000X
DCSLP000769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist