Provider Demographics
NPI:1942527064
Name:JOHNSON, DANIELLA K (MA, CCC-SLP/TSSLD)
Entity Type:Individual
Prefix:MS
First Name:DANIELLA
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP/TSSLD
Other - Prefix:MS
Other - First Name:DANIELLA
Other - Middle Name:K
Other - Last Name:CORDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:57 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3415
Mailing Address - Country:US
Mailing Address - Phone:803-235-5864
Mailing Address - Fax:845-535-3764
Practice Address - Street 1:65 PARROTT RD BLDG 10
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1025
Practice Address - Country:US
Practice Address - Phone:803-235-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3965235Z00000X
NC9496235Z00000X
NY028623235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist