Provider Demographics
NPI:1023624962
Name:SANCHEZ, DIAMOND ANGELINE (MS CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:DIAMOND
Middle Name:ANGELINE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:DIAMOND
Other - Middle Name:ANGELINE
Other - Last Name:SPRAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 E RIVERSIDE DR APT D702
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-1201
Mailing Address - Country:US
Mailing Address - Phone:352-409-7307
Mailing Address - Fax:
Practice Address - Street 1:101 UHLAND RD STE 112
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6681
Practice Address - Country:US
Practice Address - Phone:512-396-0872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117459235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117459OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION