Healthcare Provider Details

I. General information

NPI: 1770493520
Provider Name (Legal Business Name): DANIEL HOLBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11425 N DYSART RD
EL MIRAGE AZ
85335-9233
US

IV. Provider business mailing address

7374 W PALO VERDE DR
GLENDALE AZ
85303-4711
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA17740
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: