Provider Demographics
NPI:1689218000
Name:WALDRIP, DANA (HIS)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:WALDRIP
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N HIGHWAY 77 STE 7A
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1976
Mailing Address - Country:US
Mailing Address - Phone:972-937-7974
Mailing Address - Fax:972-937-7974
Practice Address - Street 1:401 N HIGHWAY 77 STE 7A
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1976
Practice Address - Country:US
Practice Address - Phone:972-937-7974
Practice Address - Fax:972-937-7974
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80599237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist