Provider Demographics
NPI:1649910779
Name:DIAZ, MADISON (MS-CCC, SLP)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MS-CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 SPRING CYPRESS RD
Mailing Address - Street 2:
Mailing Address - City:KLEIN
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3215
Mailing Address - Country:US
Mailing Address - Phone:832-249-4000
Mailing Address - Fax:
Practice Address - Street 1:7200 SPRING CYPRESS RD
Practice Address - Street 2:
Practice Address - City:KLEIN
Practice Address - State:TX
Practice Address - Zip Code:77379
Practice Address - Country:US
Practice Address - Phone:832-249-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118249235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty