Provider Demographics
NPI:1679091342
Name:DESCHAINE, DANIELLE AMI (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:AMI
Last Name:DESCHAINE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-3409
Mailing Address - Country:US
Mailing Address - Phone:773-213-7445
Mailing Address - Fax:
Practice Address - Street 1:753 JAMES AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3409
Practice Address - Country:US
Practice Address - Phone:773-213-7445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8683235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist