Provider Demographics
NPI:1639783269
Name:NORTHRUP, DANIELLE ANN (AUD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:ANN
Last Name:NORTHRUP
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 S DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1107
Mailing Address - Country:US
Mailing Address - Phone:269-271-4180
Mailing Address - Fax:
Practice Address - Street 1:1555 44TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4313
Practice Address - Country:US
Practice Address - Phone:616-249-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000899231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist