Provider Demographics
NPI:1932606605
Name:TUCKER, DANIELLE PAIGE (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:PAIGE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835-1155
Mailing Address - Country:US
Mailing Address - Phone:540-860-9016
Mailing Address - Fax:
Practice Address - Street 1:306 AYLOR GRUBBS AVE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:VA
Practice Address - Zip Code:22851-3702
Practice Address - Country:US
Practice Address - Phone:540-778-2612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008728235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist