Provider Demographics
NPI:1063441822
Name:URBANIC, DANIEL STUART (MS, CCC-A)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:STUART
Last Name:URBANIC
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4756 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8034
Mailing Address - Country:US
Mailing Address - Phone:850-994-7768
Mailing Address - Fax:
Practice Address - Street 1:312 KENMORE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-7462
Practice Address - Country:US
Practice Address - Phone:850-471-7574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA2432231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist