Provider Demographics
NPI:1104329853
Name:DANIELS, MERISSA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MERISSA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8896 WHITCHURCH CT
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-2005
Mailing Address - Country:US
Mailing Address - Phone:304-685-2850
Mailing Address - Fax:
Practice Address - Street 1:8896 WHITCHURCH CT
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-2005
Practice Address - Country:US
Practice Address - Phone:304-685-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA22022004865235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist