Provider Demographics
NPI:1740666700
Name:REESE, DANIEL (MA, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:REESE
Suffix:
Gender:M
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:PO BOX 4558
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765-4558
Mailing Address - Country:US
Mailing Address - Phone:512-940-6285
Mailing Address - Fax:
Practice Address - Street 1:1619 W 6TH ST STE 3
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-5377
Practice Address - Country:US
Practice Address - Phone:512-940-6285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111372235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist