Provider Demographics
NPI:1477012573
Name:GEORGE, DANIELLE IESHA I (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:IESHA
Last Name:GEORGE
Suffix:I
Gender:F
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 1:1964 NOSTRAND AVE APT 6B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-1509
Mailing Address - Country:US
Mailing Address - Phone:516-492-8218
Mailing Address - Fax:
Practice Address - Street 1:240 W 113TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-3306
Practice Address - Country:US
Practice Address - Phone:212-678-2898
Practice Address - Fax:212-679-2975
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1651245221235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist