Provider Demographics
NPI:1083004196
Name:SANTERO, DARCY ANNABELLE-BASQUE (MS SLP-CCC)
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:ANNABELLE-BASQUE
Last Name:SANTERO
Suffix:
Gender:F
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:DARCY
Other - Middle Name:ANNABELLE
Other - Last Name:BASQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SLP-CCC
Mailing Address - Street 1:PO BOX 1338
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422
Mailing Address - Country:US
Mailing Address - Phone:541-680-8479
Mailing Address - Fax:
Practice Address - Street 1:1500 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3705
Practice Address - Country:US
Practice Address - Phone:541-346-2578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60520987235Z00000X
OR15467235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist