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General NPI Number Information
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NPI Number | 1417378787
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Entity Type | Individual
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Provider Name | DIANA BELTRAN JACKSON M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 1318 W MONTE CRISTO RD
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City | EDINBURG
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State | TX
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Zip | 78541-7301
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Country | US
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Telephone | 956-997-3997
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Fax |
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Provider Business Mailing Address
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Address Line | 4625 ENSENADA AVE
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City | MCALLEN
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State | TX
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Zip | 78504-9731
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Country | US
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Telephone | 602-793-0494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 112130
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License Number State | TX
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