Provider Demographics
NPI:1629456041
Name:BACILE, DANIELLE LYNN
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:LYNN
Last Name:BACILE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:LYNN
Other - Last Name:MALONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6144 ROUTE 25A
Mailing Address - Street 2:SUITE 9B
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2018
Mailing Address - Country:US
Mailing Address - Phone:631-325-7755
Mailing Address - Fax:631-886-1419
Practice Address - Street 1:6144 ROUTE 25A
Practice Address - Street 2:SUITE 9B
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-2018
Practice Address - Country:US
Practice Address - Phone:631-325-7755
Practice Address - Fax:631-886-1419
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist