Provider Demographics
NPI:1811149057
Name:HIGGINS, PAULA DANIELLE (SLP-CCC)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:DANIELLE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4472 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12824-1904
Mailing Address - Country:US
Mailing Address - Phone:518-644-3111
Mailing Address - Fax:
Practice Address - Street 1:4472 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:DIAMOND POINT
Practice Address - State:NY
Practice Address - Zip Code:12824-1904
Practice Address - Country:US
Practice Address - Phone:518-644-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010433-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist