Provider Demographics
NPI:1942773478
Name:MCDANIEL, MIA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:MCDANIEL
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 1:16554 JEFFERSON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4173
Mailing Address - Country:US
Mailing Address - Phone:225-978-8365
Mailing Address - Fax:
Practice Address - Street 1:16554 JEFFERSON OAKS DR
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4173
Practice Address - Country:US
Practice Address - Phone:225-978-8365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3786235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist