Provider Demographics
NPI:1710236443
Name:PESSIA, DANIELLE MARIE (MS CCC SLP)
Entity Type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:MARIE
Last Name:PESSIA
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 1:146 FRANDEE LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2541
Mailing Address - Country:US
Mailing Address - Phone:585-737-9813
Mailing Address - Fax:
Practice Address - Street 1:146 FRANDEE LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2541
Practice Address - Country:US
Practice Address - Phone:585-737-9813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023190-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355344Medicaid