Provider Demographics
NPI:1609173418
Name:MONTERRY, DANIELLE (SLP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MONTERRY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OAKWOOD BLVD
Mailing Address - Street 2:STE 130
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-1956
Mailing Address - Country:US
Mailing Address - Phone:954-925-3844
Mailing Address - Fax:954-925-3845
Practice Address - Street 1:1 OAKWOOD BLVD
Practice Address - Street 2:STE 130
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-1956
Practice Address - Country:US
Practice Address - Phone:954-925-3844
Practice Address - Fax:954-925-3845
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ53482355S0801X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003233300Medicaid