Provider Demographics
NPI:1154729879
Name:DAIGLE, ANITA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2429
Mailing Address - Country:US
Mailing Address - Phone:203-814-2931
Mailing Address - Fax:
Practice Address - Street 1:17 WAYNE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2429
Practice Address - Country:US
Practice Address - Phone:203-814-2931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004252235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist