Provider Demographics
NPI:1073172300
Name:DANIEL, NICOLE L W (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:L W
Last Name:DANIEL
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 1:1541 ANDERSON HWY
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23040-2516
Mailing Address - Country:US
Mailing Address - Phone:804-492-4212
Mailing Address - Fax:
Practice Address - Street 1:60 SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:VA
Practice Address - Zip Code:23040-2538
Practice Address - Country:US
Practice Address - Phone:804-492-4212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA235Z00000XMedicaid