Provider Demographics
NPI:1003032954
Name:EDMONDSON, DANIELLE (AUDIOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-326-2911
Mailing Address - Fax:217-344-8047
Practice Address - Street 1:810 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2534
Practice Address - Country:US
Practice Address - Phone:217-326-2911
Practice Address - Fax:217-344-8047
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
113326OtherHEALTHLINK PROV ID
IL4117OtherHAMP PROVIDER ID
7216OtherPERSONALCARE PROV ID
IL203OtherBLUE CROSS PROV ID
140091Medicare ID - Type Unspecified