Provider Demographics
NPI:1760718902
Name:DAILEY, DEANNA NICOLE (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:NICOLE
Last Name:DAILEY
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:NICOLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPEECH LANGUAGE PATH
Mailing Address - Street 1:25298 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-7460
Mailing Address - Country:US
Mailing Address - Phone:276-698-3104
Mailing Address - Fax:865-769-0801
Practice Address - Street 1:25298 LEE HWY
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7460
Practice Address - Country:US
Practice Address - Phone:276-698-3104
Practice Address - Fax:276-698-3110
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005329235Z00000X
TN0000006541235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist