Provider Demographics
NPI:1710929559
Name:WALL, DANIELLE (AUD)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:
Last Name:WALL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 ROUTE 33
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2305
Mailing Address - Country:US
Mailing Address - Phone:732-280-7855
Mailing Address - Fax:732-280-7815
Practice Address - Street 1:3700 ROUTE 33
Practice Address - Street 2:SUITE 101
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2305
Practice Address - Country:US
Practice Address - Phone:732-280-7855
Practice Address - Fax:732-280-7815
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00082100231HA2400X, 231HA2500X, 237600000X
NJ41YA00059600231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter