Provider Demographics
NPI:1750357331
Name:PHILLIPS, DANIEL (EDD,CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:EDD,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 CARY DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-2504
Mailing Address - Country:US
Mailing Address - Phone:334-209-0371
Mailing Address - Fax:
Practice Address - Street 1:THE KIRKLIN CLINIC ENT OTOLARYNGOLOGY CLINIC
Practice Address - Street 2:6TH AVE SO
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0012
Practice Address - Country:US
Practice Address - Phone:205-934-9766
Practice Address - Fax:205-934-3993
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00424671235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51060621OtherBLUE CROSS OF AL PROVIDER