Provider Demographics
NPI:1225260029
Name:GREEN-REGISTER, DANA LEANN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LEANN
Last Name:GREEN-REGISTER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LEANN
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:P.O. BOX 1409
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020
Mailing Address - Country:US
Mailing Address - Phone:573-346-9242
Mailing Address - Fax:573-346-9290
Practice Address - Street 1:119 SERVICE ROAD
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020
Practice Address - Country:US
Practice Address - Phone:573-346-9242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO235Z00000X
MO2009023788235Z00000X
MO2010025335235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist