Provider Demographics
NPI:1932625563
Name:MCLEAN, DANIELE MARIE
Entity Type:Individual
Prefix:
First Name:DANIELE
Middle Name:MARIE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIELE
Other - Middle Name:MARIE
Other - Last Name:MCLEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:376 FRISCO WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445
Mailing Address - Country:US
Mailing Address - Phone:201-403-5826
Mailing Address - Fax:
Practice Address - Street 1:376 FRISCO WAY
Practice Address - Street 2:
Practice Address - City:HOLLY RIDGE
Practice Address - State:NC
Practice Address - Zip Code:28445-4202
Practice Address - Country:US
Practice Address - Phone:201-403-5826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00819400235Z00000X
NC13353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist