Provider Demographics
NPI:1063591030
Name:PACIFICO, DANEEN A (MS, CCC-A)
Entity type:Individual
Prefix:
First Name:DANEEN
Middle Name:A
Last Name:PACIFICO
Suffix:
Gender:F
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:PO BOX 2081
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26102-2081
Mailing Address - Country:US
Mailing Address - Phone:304-428-2403
Mailing Address - Fax:304-428-2403
Practice Address - Street 1:1122 MARKET ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4321
Practice Address - Country:US
Practice Address - Phone:304-428-2403
Practice Address - Fax:304-428-2403
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0012231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0160248000Medicaid
WV0160248000Medicaid