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General NPI Number Information
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NPI Number | 1811772338
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Entity Type | Individual
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Provider Name | DANIELLE LACIE QUAKE MA CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2023
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 105 E HIGHLAND AVE
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City | NEWPORT
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State | DE
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Zip | 19804-2708
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Country | US
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Telephone | 302-992-5535
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Fax |
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Provider Business Mailing Address
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Address Line | 400 FOULK RD APT 1B2
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City | WILMINGTON
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State | DE
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Zip | 19803-3839
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Country | US
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Telephone | 410-830-0012
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | O1-0012136
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License Number State | DE
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