Provider Demographics
NPI:1225267073
Name:DANIELS, PERSIS (MA,CCC-SLP/A)
Entity Type:Individual
Prefix:MRS
First Name:PERSIS
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MA,CCC-SLP/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12425 MILL HOUSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GEISMAR
Mailing Address - State:LA
Mailing Address - Zip Code:70734
Mailing Address - Country:US
Mailing Address - Phone:225-673-6837
Mailing Address - Fax:
Practice Address - Street 1:12425 MILL HOUSE DRIVE
Practice Address - Street 2:
Practice Address - City:GEISMAR
Practice Address - State:LA
Practice Address - Zip Code:70734
Practice Address - Country:US
Practice Address - Phone:225-673-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4008231H00000X, 231HA2400X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner