Healthcare Provider Details

I. General information

NPI: 1235059817
Provider Name (Legal Business Name): DANIELLE OLIVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 E FLORENCE BLVD
CASA GRANDE AZ
85122-5358
US

IV. Provider business mailing address

11074 W DENIER DR
MARANA AZ
85653-8272
US

V. Phone/Fax

Practice location:
  • Phone: 602-684-6622
  • Fax:
Mailing address:
  • Phone: 310-497-6349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17873
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: