Provider Demographics
NPI:1760519441
Name:MASON, DANIEL SHANE (CCC-A)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:SHANE
Last Name:MASON
Suffix:
Gender:M
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-1331
Mailing Address - Country:US
Mailing Address - Phone:304-455-2739
Mailing Address - Fax:304-455-2739
Practice Address - Street 1:179 NORTH ST
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-1331
Practice Address - Country:US
Practice Address - Phone:304-455-2739
Practice Address - Fax:304-455-2739
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV-0042231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist