Healthcare Provider Details

I. General information

NPI: 1033024534
Provider Name (Legal Business Name): DANIELLE NICOLE COUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S KEOWEE ST
DAYTON OH
45402-2242
US

IV. Provider business mailing address

200 S KEOWEE ST
DAYTON OH
45402-2242
US

V. Phone/Fax

Practice location:
  • Phone: 937-225-4598
  • Fax:
Mailing address:
  • Phone: 937-225-4598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.20263450-SLP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: