Provider Demographics
NPI:1942382031
Name:GLEASON, DANIEL (HIS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GLEASON
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 OLSEN BLVD UNIT 6
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3070
Mailing Address - Country:US
Mailing Address - Phone:806-355-9957
Mailing Address - Fax:806-356-9963
Practice Address - Street 1:3801 OLSEN BLVD UNIT 6
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3070
Practice Address - Country:US
Practice Address - Phone:806-355-9957
Practice Address - Fax:806-356-9963
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3903237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist