Healthcare Provider Details

I. General information

NPI: 1437375110
Provider Name (Legal Business Name): DANIELLE LOCKE M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 SAINT JOHNS RD
DRUMS PA
18222-1803
US

IV. Provider business mailing address

PO BOX 394
GORDON PA
17936-0394
US

V. Phone/Fax

Practice location:
  • Phone: 570-788-8320
  • Fax: 570-788-8321
Mailing address:
  • Phone: 570-590-2659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL007731
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1017212580003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: