Provider Demographics
NPI:1558832139
Name:DOUGLAS-HILEY, DANA (MA,CCC)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:DOUGLAS-HILEY
Suffix:
Gender:F
Credentials:MA,CCC
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:NIIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC
Mailing Address - Street 1:9606 TIERRA GRANDE ST.
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126
Mailing Address - Country:US
Mailing Address - Phone:858-695-9415
Mailing Address - Fax:858-695-9415
Practice Address - Street 1:9606 TIERRA GRANDE ST.
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126
Practice Address - Country:US
Practice Address - Phone:858-695-9415
Practice Address - Fax:858-695-9415
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP28031235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist