Provider Demographics
NPI:1558819086
Name:BUCKLEY, DANIEL PAUL (SLP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:PAUL
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:SLP
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 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-5790
Mailing Address - Fax:
Practice Address - Street 1:1450 SAN PABLO ST
Practice Address - Street 2:SUITE 5100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-4500
Practice Address - Country:US
Practice Address - Phone:323-442-5790
Practice Address - Fax:323-442-2097
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11024235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist