Provider Demographics
NPI:1417950338
Name:KALIES, DAKSHA K (AUD)
Entity Type:Individual
Prefix:DR
First Name:DAKSHA
Middle Name:K
Last Name:KALIES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78335-0611
Mailing Address - Country:US
Mailing Address - Phone:361-758-0376
Mailing Address - Fax:361-758-0378
Practice Address - Street 1:1016 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-5306
Practice Address - Country:US
Practice Address - Phone:361-758-0376
Practice Address - Fax:361-758-0378
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51116231H00000X
TX90679237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX528449OtherBCBS NUMBER
TX022391902Medicaid
TX00Y803Medicare PIN