Provider Demographics
NPI:1124481767
Name:VERNON, DANIELLE NICOLE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NICOLE
Last Name:VERNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12155 SW TOOZE RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8441
Mailing Address - Country:US
Mailing Address - Phone:503-570-0147
Mailing Address - Fax:
Practice Address - Street 1:12155 SW TOOZE RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-8441
Practice Address - Country:US
Practice Address - Phone:503-570-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORABA-IN-10175432252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency