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General NPI Number Information
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NPI Number | 1316230105
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Entity Type | Individual
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Provider Name | ANTOINETTE DANIELS SLPA, LAC
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Gender | Female
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 204 N RHODES ST
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-3944
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Country | US
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Telephone | 870-400-8080
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Fax | 870-400-8079
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Provider Business Mailing Address
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Address Line | PO BOX 11064
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-1001
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Country | US
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Telephone | 870-520-5014
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A2503011
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License Number State | AR
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