MEDICARE: DEBORA A DANIELS MA 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
1	235Z00000X	Speech-Language Pathologist	164	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	29541028	OTHER		BCBS PROVIDER #

General Provider Information

NPI Number	:	1821102880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORA A DANIELS MA SLP

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	STILWELL
State	:	KS
Zip	:	66085-0307
Country	:	US
Telephone Number	:	866-249-9736
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD.
Second Line	:	2032 SCHOOL OF NURSING, MAIL STOP 4043
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-7389
Country	:	US
Telephone Number	:	866-249-9736
Fax Number	:

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	05/28/2009

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