Provider Demographics
NPI:1336312321
Name:MCDANIEL, ERIC WARREN (MS CCC-A)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:WARREN
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SPRINGFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-5522
Mailing Address - Country:US
Mailing Address - Phone:270-791-1149
Mailing Address - Fax:
Practice Address - Street 1:108 SPRINGFIELD CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-5522
Practice Address - Country:US
Practice Address - Phone:270-791-1149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0477231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist