Provider Demographics
NPI:1083992168
Name:TEDESCO, DANIELLE H (MA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:H
Last Name:TEDESCO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:H
Other - Last Name:FORREST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:1138 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-8311
Mailing Address - Country:US
Mailing Address - Phone:716-628-1137
Mailing Address - Fax:
Practice Address - Street 1:1500 COLVIN BLVD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14223-1118
Practice Address - Country:US
Practice Address - Phone:716-874-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-24
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022318-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist