Provider Demographics
NPI:1598214975
Name:MCCALLISTER, DANIELLE (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MCCALLISTER
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 LAKE ASBURY DR
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-9555
Mailing Address - Country:US
Mailing Address - Phone:386-288-6647
Mailing Address - Fax:904-592-5333
Practice Address - Street 1:108 KINGSLEY AVE STE 2
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5686
Practice Address - Country:US
Practice Address - Phone:386-288-6647
Practice Address - Fax:904-592-5333
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist