Provider Demographics
NPI:1700981495
Name:HUNTSMAN, DANA MICHELLE (MCD CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MICHELLE
Last Name:HUNTSMAN
Suffix:
Gender:F
Credentials:MCD CCCSLP
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MICHELLE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD CCCSLP
Mailing Address - Street 1:2525 WALLINGWOOD
Mailing Address - Street 2:BLDG 2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-327-6179
Mailing Address - Fax:512-327-1545
Practice Address - Street 1:2525 WALLINGWOOD
Practice Address - Street 2:BLDG 2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-327-6179
Practice Address - Fax:512-327-6179
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102475235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist