Healthcare Provider Details

I. General information

NPI: 1225521131
Provider Name (Legal Business Name): DANIELLE MIESCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 AMORY ST
JAMAICA PLAIN MA
02130-2652
US

IV. Provider business mailing address

555 AMORY ST
JAMAICA PLAIN MA
02130-2652
US

V. Phone/Fax

Practice location:
  • Phone: 617-383-6522
  • Fax:
Mailing address:
  • Phone: 617-383-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: