Provider Demographics
NPI:1780801936
Name:MCCOOL, DANIEL DOUGLAS
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:DOUGLAS
Last Name:MCCOOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:113 DIVISION
Mailing Address - City:SPARTA
Mailing Address - State:MO
Mailing Address - Zip Code:65753-0160
Mailing Address - Country:US
Mailing Address - Phone:417-634-3223
Mailing Address - Fax:417-634-3156
Practice Address - Street 1:SCHOOL DIST R 3 SPARTA
Practice Address - Street 2:113 DIVISION
Practice Address - City:SPARTA
Practice Address - State:MO
Practice Address - Zip Code:65753-0160
Practice Address - Country:US
Practice Address - Phone:417-634-3223
Practice Address - Fax:417-634-3156
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004008771235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO467564506Medicaid