Healthcare Provider Details

I. General information

NPI: 1245187574
Provider Name (Legal Business Name): STEPHANIE GONZALEZ DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 BRANDON AVE STE 130
SPRINGFIELD VA
22150-2519
US

IV. Provider business mailing address

8745 WOODLAWN RD
FORT BELVOIR VA
22060-5277
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-7500
  • Fax:
Mailing address:
  • Phone: 703-569-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: