Provider Demographics
NPI:1669660353
Name:DANIEL, KENNETH GAIL (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KENNETH
Middle Name:GAIL
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MAKES CRY-DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 N DANIEL ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-4417
Mailing Address - Country:US
Mailing Address - Phone:580-330-0218
Mailing Address - Fax:
Practice Address - Street 1:515 N DANIEL ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-4417
Practice Address - Country:US
Practice Address - Phone:580-330-0218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2726174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist