Basic Information
| Provider Information | |||||||||
| NPI: | 1164447793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANIELS | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | LYNN | ||||||||
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| OtherLastName: | DANIELS | ||||||||
| OtherFirstName: | SHASHI | ||||||||
| OtherMiddleName: | L | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5000 CHESHIRE LN N | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554463706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883339152 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1034 116TH AVE NE | ||||||||
| Address2: | SUITE B 3 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980044614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254555596 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | LD00002967 | WA | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.