Provider Demographics
NPI:1972852804
Name:MALOUFF, DANIELLE ROSE (MA,CCCC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ROSE
Last Name:MALOUFF
Suffix:
Gender:F
Credentials:MA,CCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7565 JULYNN RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-4232
Mailing Address - Country:US
Mailing Address - Phone:719-242-4545
Mailing Address - Fax:
Practice Address - Street 1:7565 JULYNN RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-4232
Practice Address - Country:US
Practice Address - Phone:719-242-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0455536235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist