MEDICARE: MISS PEYTON NICOLE DIAZ M.A., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	201545	AR

General Provider Information

NPI Number	:	1073031142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PEYTON NICOLE DIAZ M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	1919 NORTHEASTERN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-2934
Country	:	US
Telephone Number	:	501-241-2080
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 LINDA LN
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-2851
Country	:	US
Telephone Number	:	501-241-2080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2017
Last Update Date	:	10/02/2025

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Directions to “ MISS PEYTON NICOLE DIAZ M.A., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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