Basic Information
| Provider Information | |||||||||
| NPI: | 1982105532 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKINNEY | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1609 | ||||||||
| Address2: | |||||||||
| City: | CHALMETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700441609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858052555 | ||||||||
| FaxNumber: | 9854005303 | ||||||||
| Practice Location | |||||||||
| Address1: | 5001 HIGHWAY 190 EAST SERVICE RD STE D6 | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704334956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858052555 | ||||||||
| FaxNumber: | 9854005303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2018 | ||||||||
| LastUpdateDate: | 03/21/2018 | ||||||||
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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 | 235Z00000X | 5864 | LA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.