Provider Demographics
NPI:1457577009
Name:MENDELSOHN, DANIEL L (BC-HIS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:MENDELSOHN
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 N TRAVIS ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-5029
Mailing Address - Country:US
Mailing Address - Phone:903-892-1597
Mailing Address - Fax:903-892-0686
Practice Address - Street 1:903 N TRAVIS ST
Practice Address - Street 2:SUITE C
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-5029
Practice Address - Country:US
Practice Address - Phone:903-892-1597
Practice Address - Fax:903-892-0686
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50493237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX528128OtherBCBS