Provider Demographics
NPI:1417262130
Name:CALDWELL, DARA MARIAMA
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:MARIAMA
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1099 E ORANGE GROVE BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-4647
Mailing Address - Country:US
Mailing Address - Phone:818-472-0251
Mailing Address - Fax:
Practice Address - Street 1:1099 E ORANGE GROVE BLVD APT 2
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-4647
Practice Address - Country:US
Practice Address - Phone:818-472-0251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 15108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist