Provider Demographics
NPI:1811772338
Name:QUAKE, DANIELLE LACIE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LACIE
Last Name:QUAKE
Suffix:
Gender:F
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 1:400 FOULK RD APT 1B2
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3839
Mailing Address - Country:US
Mailing Address - Phone:410-830-0012
Mailing Address - Fax:
Practice Address - Street 1:105 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:DE
Practice Address - Zip Code:19804-2708
Practice Address - Country:US
Practice Address - Phone:302-992-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO1-0012136235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist