Provider Demographics
NPI:1710236658
Name:NELSON, DAN'ELLE
Entity Type:Individual
Prefix:
First Name:DAN'ELLE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18601 BAINBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5312
Mailing Address - Country:US
Mailing Address - Phone:248-792-7535
Mailing Address - Fax:
Practice Address - Street 1:20542 HARPER AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1693
Practice Address - Country:US
Practice Address - Phone:313-571-3908
Practice Address - Fax:313-571-3909
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6065003OtherMEDICARE (PTAN)