Basic Information
| Provider Information | |||||||||
| NPI: | 1518079235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANIELS | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | CHAD | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3201 S MARYLAND PKWY | ||||||||
| Address2: | STE 300 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891092425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013731108 | ||||||||
| FaxNumber: | 8013734008 | ||||||||
| Practice Location | |||||||||
| Address1: | 2545 NORTH CANYON ROAD | ||||||||
| Address2: | #100 | ||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013731108 | ||||||||
| FaxNumber: | 8013734008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 08/15/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 5293696-4101 | UT | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.