Basic Information
Provider Information | |||||||||
NPI: | 1922235985 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HERRINGTON | ||||||||
FirstName: | DANA | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.S., CCC-SLP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HUSAIM | ||||||||
OtherFirstName: | DANA | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.S., CF-SLP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 6084 STEVENSON DR | ||||||||
Address2: | #309 | ||||||||
City: | ORLANDO | ||||||||
State: | FL | ||||||||
PostalCode: | 328352429 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7275809178 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 448 W DONEGAN AVE | ||||||||
Address2: |   | ||||||||
City: | KISSIMMEE | ||||||||
State: | FL | ||||||||
PostalCode: | 347412335 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4079323445 | ||||||||
FaxNumber: | 4079323480 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/17/2009 | ||||||||
LastUpdateDate: | 01/25/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA 9967 | FL | Y |   | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   |
ID Information
ID | Type | State | Issuer | Description | 8810363001 | 01 | FL | CIGNA | OTHER | 880357904 | 05 | FL |   | MEDICAID | 592984541 | 01 | FL | TRICARE | OTHER | Y906F | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 6406221 | 01 | FL | UNITED HEALTHCARE | OTHER |