Provider Demographics
NPI:1063765543
Name:LYONS, DANIEL MICHAEL
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:MICHAEL
Last Name:LYONS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:MICHAEL
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:3010 WILSON AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1242
Mailing Address - Country:US
Mailing Address - Phone:616-249-8141
Mailing Address - Fax:616-249-8147
Practice Address - Street 1:3010 WILSON AVE SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1242
Practice Address - Country:US
Practice Address - Phone:616-249-8141
Practice Address - Fax:616-249-8147
Is Sole Proprietor?:No
Enumeration Date:2012-10-20
Last Update Date:2012-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner