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General NPI Number Information
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NPI Number | 1598214975
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Entity Type | Individual
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Provider Name | DANIELLE MCCALLISTER M.ED. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 108 KINGSLEY AVE STE 2
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City | ORANGE PARK
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State | FL
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Zip | 32073-5686
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Country | US
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Telephone | 386-288-6647
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Fax | 904-592-5333
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Provider Business Mailing Address
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Address Line | 1057 LAKE ASBURY DR
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-9555
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Country | US
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Telephone | 386-288-6647
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Fax | 904-592-5333
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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