Provider Demographics
NPI:1942601471
Name:DIAZ, VANESSA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:PORT READING
Mailing Address - State:NJ
Mailing Address - Zip Code:07064-1226
Mailing Address - Country:US
Mailing Address - Phone:908-380-6425
Mailing Address - Fax:
Practice Address - Street 1:209 WILLOW ST
Practice Address - Street 2:
Practice Address - City:PORT READING
Practice Address - State:NJ
Practice Address - Zip Code:07064-1226
Practice Address - Country:US
Practice Address - Phone:908-380-6425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist