Provider Demographics
NPI:1275852642
Name:MASON, DANIEL FREDERICK (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:FREDERICK
Last Name:MASON
Suffix:
Gender:M
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 1:1814 N WOOD ST
Mailing Address - Street 2:APT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-7836
Mailing Address - Country:US
Mailing Address - Phone:312-725-9612
Mailing Address - Fax:
Practice Address - Street 1:1814 N WOOD ST
Practice Address - Street 2:APT 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-7836
Practice Address - Country:US
Practice Address - Phone:508-728-6185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
MASP-9083-SL235Z00000X
NH1508235Z00000X
IL146012075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist