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NPI Code Detail

MEDICARE: KELLY MCDANIEL CCC-SLP

MEDICARE: KELLY MCDANIEL CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist117183TX

General Provider Information

NPI Number : 1124697602
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY MCDANIEL CCC-SLP
Provider Business Mailing Address
First Line : 3964 WATERCOURSE DR APT 1437
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-2089
Country : US
Telephone Number : 432-940-6912
Fax Number :
Provider Business Practice Location Address
First Line : 4400 OAK PARK LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-9534
Country : US
Telephone Number : 469-892-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2021
Last Update Date : 06/21/2021

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Directions to “ KELLY MCDANIEL CCC-SLP” Practice Location

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