Provider Demographics
NPI:1538560388
Name:DIAZ, LEAH DANIELLE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:DANIELLE
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 1:6924 W LINEBAUGH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-5800
Mailing Address - Country:US
Mailing Address - Phone:813-962-6766
Mailing Address - Fax:
Practice Address - Street 1:6924 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-5800
Practice Address - Country:US
Practice Address - Phone:813-962-6766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16780235Z00000X
FLSI24882355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist