Provider Demographics
NPI:1770912552
Name:FINSTROM, DANIEL LEE (MA; CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LEE
Last Name:FINSTROM
Suffix:
Gender:M
Credentials:MA; CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7708 CHIPPEWA ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4869
Mailing Address - Country:US
Mailing Address - Phone:269-375-2020
Mailing Address - Fax:269-375-7990
Practice Address - Street 1:1701 S 11TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1775
Practice Address - Country:US
Practice Address - Phone:269-375-2020
Practice Address - Fax:269-375-2020
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI09149417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1306893805Medicaid