Provider Demographics
NPI:1518079235
Name:DANIELS, GARY CHAD (MS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:CHAD
Last Name:DANIELS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 S MARYLAND PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2425
Mailing Address - Country:US
Mailing Address - Phone:801-373-1108
Mailing Address - Fax:801-373-4008
Practice Address - Street 1:2545 NORTH CANYON ROAD
Practice Address - Street 2:#100
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84057
Practice Address - Country:US
Practice Address - Phone:801-373-1108
Practice Address - Fax:801-373-4008
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5293696-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP99558Medicare UPIN