Provider Demographics
NPI:1679099261
Name:DANIEL, KATIE E (MS/CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:E
Last Name:DANIEL
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 1:1 CIRCLE DR APT 2
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:IL
Mailing Address - Zip Code:62839-2346
Mailing Address - Country:US
Mailing Address - Phone:618-662-0061
Mailing Address - Fax:
Practice Address - Street 1:405 S MAIN ST
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:IL
Practice Address - Zip Code:62849-1011
Practice Address - Country:US
Practice Address - Phone:618-323-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist