Provider Demographics
NPI:1659156107
Name:MAUCK, DARA MICHELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:MICHELLE
Last Name:MAUCK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 BROOKWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-9041
Mailing Address - Country:US
Mailing Address - Phone:786-222-2110
Mailing Address - Fax:
Practice Address - Street 1:1251 BROOKWOOD FOREST BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-9041
Practice Address - Country:US
Practice Address - Phone:786-222-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202435235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist