Provider Demographics
NPI:1053556233
Name:DANIELS, MARY CATHERINE (SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CATHERINE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 PRIM RD
Mailing Address - Street 2:PEDIATRIC REHAB TEAM
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-6403
Mailing Address - Country:US
Mailing Address - Phone:802-860-4461
Mailing Address - Fax:802-860-4454
Practice Address - Street 1:1110 PRIM RD
Practice Address - Street 2:PEDIATRIC REHAB TEAM
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-6403
Practice Address - Country:US
Practice Address - Phone:802-860-4461
Practice Address - Fax:802-860-4454
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist