Provider Demographics
NPI:1750722633
Name:DANIEL, AIMEE NOELLE (MED CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:AIMEE
Middle Name:NOELLE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 5TH ST SW
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:FL
Mailing Address - Zip Code:32052-6068
Mailing Address - Country:US
Mailing Address - Phone:386-397-9416
Mailing Address - Fax:
Practice Address - Street 1:405 11TH ST SW
Practice Address - Street 2:SUITE 205
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-3161
Practice Address - Country:US
Practice Address - Phone:386-397-9416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12276235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist