Basic Information
| Provider Information | |||||||||
| NPI: | 1619574100 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIBLEY | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | DEMARINO | ||||||||
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| Credential: | MS-CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5220 SPRING VALLEY RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752542512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2144661340 | ||||||||
| FaxNumber: | 2144661378 | ||||||||
| Practice Location | |||||||||
| Address1: | 17480 DALLAS PKWY STE 221 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752877361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692918500 | ||||||||
| FaxNumber: | 8663414198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2020 | ||||||||
| LastUpdateDate: | 10/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | PENDING | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.