Provider Demographics
NPI:1043386261
Name:WALTERS, DANIELLE B (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:B
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6697 LOCHSIDE LN
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-9150
Mailing Address - Country:US
Mailing Address - Phone:608-225-1388
Mailing Address - Fax:608-834-0734
Practice Address - Street 1:6697 LOCHSIDE LN
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-9150
Practice Address - Country:US
Practice Address - Phone:608-225-1388
Practice Address - Fax:608-834-0734
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2022-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42784600Medicaid