Provider Demographics
NPI:1457991788
Name:BREDL, DANA DIANTONIO (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:DIANTONIO
Last Name:BREDL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:DIANTONIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:532 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4845
Mailing Address - Country:US
Mailing Address - Phone:772-362-9370
Mailing Address - Fax:
Practice Address - Street 1:532 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4845
Practice Address - Country:US
Practice Address - Phone:772-362-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17976235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107168700Medicaid
FL105274300Medicaid