MEDICARE: MS. MARY ELIZABETH DANIELS

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
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1689986952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ELIZABETH DANIELS

Provider Business Mailing Address
First Line	:	12 20TH AVE
Second Line	:
City	:	ISLE OF PALMS
State	:	SC
Zip	:	29451-2209
Country	:	US
Telephone Number	:	704-775-8003
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 LIBERTY MIDTOWN DR APT 420
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-4983
Country	:	US
Telephone Number	:	843-936-2801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	07/03/2024

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