Provider Demographics
NPI:1841549037
Name:DANIELS, BRENDA YVONNE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:YVONNE
Last Name:DANIELS
Suffix:
Gender:F
Credentials: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:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-0326
Mailing Address - Country:US
Mailing Address - Phone:918-649-0338
Mailing Address - Fax:918-649-0331
Practice Address - Street 1:404 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4214
Practice Address - Country:US
Practice Address - Phone:918-649-0338
Practice Address - Fax:918-649-0331
Is Sole Proprietor?:No
Enumeration Date:2012-09-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist