Provider Demographics
NPI:1669406849
Name:DANHAUER, JEFFREY LYNN (PHD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LYNN
Last Name:DANHAUER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 N FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-1837
Mailing Address - Country:US
Mailing Address - Phone:805-683-5322
Mailing Address - Fax:805-683-4302
Practice Address - Street 1:191 BURTON MESA BLVD
Practice Address - Street 2:STE. C
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-1400
Practice Address - Country:US
Practice Address - Phone:805-733-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAUD512231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU000512Medicaid
CAAU000512AMedicaid
CAAUD512AMedicare ID - Type Unspecified
CAAUD512Medicare ID - Type UnspecifiedAUDIOLOGIST