Provider Demographics
NPI:1689917627
Name:THOMAS MIRR, DAPHYNE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DAPHYNE
Middle Name:
Last Name:THOMAS MIRR
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SUNSET CREEK LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-3814
Mailing Address - Country:US
Mailing Address - Phone:925-249-0360
Mailing Address - Fax:
Practice Address - Street 1:210 PORTER DR
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1588
Practice Address - Country:US
Practice Address - Phone:925-743-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15289235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist