Provider Demographics
NPI:1760047674
Name:DANIELS, MAURA CAITLIN (AUD)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:CAITLIN
Last Name:DANIELS
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 1:2100 NE BROADWAY ST STE 305
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1570
Mailing Address - Country:US
Mailing Address - Phone:503-236-3368
Mailing Address - Fax:
Practice Address - Street 1:2100 NE BROADWAY ST STE 305
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1570
Practice Address - Country:US
Practice Address - Phone:503-236-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR030939231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist