Healthcare Provider Details

I. General information

NPI: 1851028575
Provider Name (Legal Business Name): DANIELLE SIMON SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 36TH AVE S
FARGO ND
58104-5274
US

IV. Provider business mailing address

4500 36TH AVE S STE 200
FARGO ND
58104-5275
US

V. Phone/Fax

Practice location:
  • Phone: 701-532-1507
  • Fax:
Mailing address:
  • Phone: 701-532-1507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2384
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: