Provider Demographics
NPI:1942505805
Name:MNTANGA, DANIELLE JONES (MA)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:JONES
Last Name:MNTANGA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:SHAREE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:8056 VENETIAN DR APT 8
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2557
Mailing Address - Country:US
Mailing Address - Phone:714-356-6939
Mailing Address - Fax:
Practice Address - Street 1:8056 VENETIAN DR APT 8
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-2557
Practice Address - Country:US
Practice Address - Phone:714-356-6939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015004091103K00000X, 103K00000X
MO2014039045235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist