Provider Demographics
NPI:1811010812
Name:THOMPSON, DANIELLE MARCE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:MARCE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials: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 1382
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-1382
Mailing Address - Country:US
Mailing Address - Phone:907-299-1482
Mailing Address - Fax:907-235-6082
Practice Address - Street 1:4281 SHIRLEY CT
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7227
Practice Address - Country:US
Practice Address - Phone:907-299-1482
Practice Address - Fax:907-235-6082
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKSP01391Medicaid
AKSP0139Medicaid