Provider Demographics
NPI:1871629147
Name:DUNKELBERGER, DANIEL WALLACE (AUD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:WALLACE
Last Name:DUNKELBERGER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 E SHAMOKIN ST
Mailing Address - Street 2:
Mailing Address - City:TREVORTON
Mailing Address - State:PA
Mailing Address - Zip Code:17881-1620
Mailing Address - Country:US
Mailing Address - Phone:570-797-2112
Mailing Address - Fax:
Practice Address - Street 1:264 E SHAMOKIN ST
Practice Address - Street 2:
Practice Address - City:TREVORTON
Practice Address - State:PA
Practice Address - Zip Code:17881-1620
Practice Address - Country:US
Practice Address - Phone:570-797-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000147L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist