Provider Demographics
NPI:1114394541
Name:HEWITT, DANIELLE (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:HEWITT
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 17TH ST
Mailing Address - Street 2:ATTN. AUDIOLOGY TSOB
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5351
Mailing Address - Country:US
Mailing Address - Phone:812-376-5695
Mailing Address - Fax:812-375-3702
Practice Address - Street 1:3015 10TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-6603
Practice Address - Country:US
Practice Address - Phone:812-376-5695
Practice Address - Fax:812-375-3702
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001464A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist