Provider Demographics
NPI:1457862187
Name:ARNOLD, DANA LEIGH (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:LEIGH
Last Name:ARNOLD
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 1:3105 W WOODLAWN PL
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5555
Mailing Address - Country:US
Mailing Address - Phone:618-985-8742
Mailing Address - Fax:
Practice Address - Street 1:1405 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-2303
Practice Address - Country:US
Practice Address - Phone:618-985-8742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL524128235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist