Provider Demographics
NPI:1881234722
Name:SHOCK, DANIELLE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:SHOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SAGEBRUSH LN
Mailing Address - Street 2:
Mailing Address - City:ROMANCE
Mailing Address - State:AR
Mailing Address - Zip Code:72136-6922
Mailing Address - Country:US
Mailing Address - Phone:501-849-4016
Mailing Address - Fax:
Practice Address - Street 1:WILBUR MILLS COOP
Practice Address - Street 2:114 N MAIN
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012
Practice Address - Country:US
Practice Address - Phone:501-882-3852
Practice Address - Fax:501-882-1025
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist