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NPI Code Detail

MEDICARE: DANIELLE LACIE QUAKE MA CCC-SLP

MEDICARE: DANIELLE LACIE QUAKE MA CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistO1-0012136DE

General Provider Information

NPI Number : 1811772338
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE LACIE QUAKE MA CCC-SLP
Provider Business Mailing Address
First Line : 400 FOULK RD APT 1B2
Second Line :
City : WILMINGTON
State : DE
Zip : 19803-3839
Country : US
Telephone Number : 410-830-0012
Fax Number :
Provider Business Practice Location Address
First Line : 105 E HIGHLAND AVE
Second Line :
City : NEWPORT
State : DE
Zip : 19804-2708
Country : US
Telephone Number : 302-992-5535
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2023
Last Update Date : 08/31/2023

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Directions to “ DANIELLE LACIE QUAKE MA CCC-SLP” Practice Location

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